Non-inflammatory musculoskeletal disorders in childhood

Musculoskeletal manifestations in pediatric patients infected with human immunodeficiency virus: Developing country perspective

OBJECTIVE

Musculoskeletal manifestations in children infected with human immunodeficiency virus (HIV) are responsible for increased morbidity and decreased quality of life. Even in this era of highly active anti-retroviral therapy (HAART), there are limited studies on different rheumatological manifestations in pediatric patients with HIV, and the spectrum of musculoskeletal manifestation in pediatric HIV is yet to be established.

METHODS

A single-center, prospective, observational study was carried out from October 2014 to September 2016 in a tertiary care hospital of Eastern India with 517 children infected with HIV aged between 3 and 19 years. Particulars of musculoskeletal involvement were at first screened with pediatric gait, arm, leg, spine (pGALS) screening protocol, followed by detailed examination in patients identified through screening. All the participants were re-examined at three and six months of follow-up.

RESULTS

Musculoskeletal manifestations were found in 11.2% of the study population. The most common non-infective manifestation found in the study population was arthralgia (5.22%), followed by myalgia (3.29%). The prevalence of definite arthritis was found to be 6/1000 children, whereas infective manifestations (including arthritis, myositis, and osteomyelitis) were found in 2.12% of study population. Musculoskeletal manifestations were commonly found in children infected with HIV who were on anti-retroviral drugs. These manifestations were found commonly in the children in the second decade of their lives. Malnutrition, advanced stage of HIV infection (WHO clinical stage 4), lower CD4 count at the time of evaluation, and longer duration of disease were associated with increased frequency of musculoskeletal manifestations.

CONCLUSION

Musculoskeletal manifestations are frequent in pediatric population infected with HIV. But for better delineation, further multicentric studies are warranted in future in children infected with HIV.

Neurologic disorders masquerading as pediatric sleep problems

Neurologic disorders may present or masquerade as pediatric sleep problems and fool the pediatrician, which may delay diagnosis and treatment. Many of the sleep problems in children with neurologic disorders arise directly from primary dysfunction or delayed maturation of their sleep-wake regulation systems. It is important to realize that nocturnal frontal lobe seizures or cluster headaches can be mistaken for night terrors, and craniopharyngiomas or myotonic dystrophy may present as narcolepsy-cataplexy. Hypothalamic dysfunction may explain not only the impaired circadian rhythm disorders in children with profound mental retardation but also excessive sleepiness and hyperphagia in Prader-Willi and Kleine-Levin syndromes. Intellectually challenged children perform better, learn more, and are better behaved with sufficient restorative sleep.

Initial evaluation of a child with arthritis--an algorithmic approach

Arthritis is one of the less common, yet challenging problems that may confront a pediatrician. The potential pathology is diverse ranging from the benign with a good prognosis to the serious and ultimately fatal. From a spot diagnosis to conditions that evolve over time, few other conditions challenge and stimulate the clinical acumen. Several diagnoses can be made clinically with the laboratory investigations providing additional support. An approach through which the clinician seeks answers through a logical sequence of questions is presented to help shortlist the possible diagnosis.

Repetitive strain injuries in youth

PURPOSE

To review the anatomic and physiologic considerations in repetitive strain injuries (RSI) in youth in relation to normal growth and development.

DATA SOURCES

Extensive review of scientific literature, laws relating to youth labor, and the authors' experience.

CONCLUSIONS

Early detection of youth at risk for RSIs is crucial for prevention and treatment. Physical maturity and size are more important than chronological age in the safe performance of work tasks or sports.

IMPLICATIONS FOR PRACTICE

Interventions that reduce injury in youth include gradually increasing training load, improving flexibility, and strength, improving biomechanics, and correcting malalignment. Assessments should include tests of flexibility, laxity, and muscle symmetry.

Reflex sympathetic dystrophy in children

Reflex sympathetic dystrophy is a syndrome characterized by pain in one or more extremities, usually associated with vasomotor changes. Its occurrence in childhood has long been thought to be rare. We describe six cases of pediatric reflex sympathetic dystrophy and suggest that this syndrome could be underdiagnosed in children and adolescents. Psychologic problems frequently play a role in this disorder, which often can be treated conservatively. We also point out that the diagnosis is mainly clinical. An early diagnosis can avoid unnecessary tests and potentially can improve response to treatment, and prognosis.