Serious diagnoses and associated findings in children with joint pain and/or swelling

Emergency diagnoses	Typical clinical features	Investigations
Septic arthritis or osteomyelitis	Hectic, spiking fever; ill appearance; rash; rapid-onset monoarthritis; pseudo-paralysis; pinpoint bony tenderness	Blood cultures, arthrocentesis for microscopy and culture, blood count, imaging of affected bone/joint (plain radiograph, CT scan)
Kawasaki disease	Hectic fever, irritable infant, sentinel cervical lymph node, conjunctivitis, oral mucositis, peripheral arthralgia/edema, rash, carditis, peeling fingertips	Echocardiography, exclude sepsis, blood count and acute phase proteins
Neoplasia	Irritability, pallor, unexplained bruising, bone pain (especially nocturnal)	Blood count, bone marrow examination, abdominal ultrasound, imaging of affected area
Nonaccidental injury	Disparities between history given and features on examination, irritability, pallor, unexplained bruising and other injuries, bone pain	Blood count, bleeding and clotting studies, skeletal survey, refer to child protection procedures for your hospital

CT: computed tomography.

Courtesy of Taunton R Southwood, MD, FRACP, FRCPA, FRCP, FRCPCH and Yukiko Kimura, MD.

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