Incorporating Joint Pain Screening into the Pediatrics Derma
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Joint manifestations are a common feature of many pediatric skin disorders, among them being psoriasis, autoimmune and autoinflammatory diseases, and hypermobility disorders.

Catching joint problems early is important to prevent progressive joint damage, with earlier intervention of appropriate therapy. Pediatrics rheumatology is an underserved specialty, and wait times can be long. The intention of this paper is to aid pediatric dermatologists in differentiating joint manifestations requiring more urgent triage to pediatric rheumatology for inflammatory arthritis or synovitis.

After review of the literature, and survey of 100 practicing board?certified pediatric dermatologists, most of whom (79%) noted low confidence in performing a joint?focused physical examination, the researchers created the rapid joint examination technique (R-JET), a 1-minute joint exam that can be performed in a busy pediatric dermatology clinic. A video demonstration of the R-JET was created as a teaching tool.

The R-JET is amazingly simple to administer and begins with clarifying questions asked to the patient/parent to determine whether the joint pain is more likely inflammatory or mechanical. These include timing of the pain (morning pain is more consistent with inflammatory arthritis), chronicity (>6 weeks typically suggests an inflammatory cause), and severity.

These questions are directed to children aged ?8 years with a visual diagram to help localize areas of pain. The examination itself is easy to implement and focuses on the joints most likely to have involvement in three particular disorders with skin manifestations: psoriatic arthritis, systemic lupus erythematosus, and Henoch-Schönleinpurpura.

Teaching and incorporation of a rapid screening examination for arthritis by pediatric dermatologists has the potential to identify pediatric arthritis earlier, facilitate referral, and reduce the risk of progressive joint disease, researchers concluded. “These instruments can easily be incorporated into a pediatric dermatology office visit.”