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Çocuk romatoloji polikliğine bacak ağrısı nedeni ile başvuran hastaların değerlendirilmesi: Tek merkez deneyimi

Yıl 2020, Cilt: 12 Sayı: 2, 181 - 185, 01.06.2020
https://doi.org/10.21601/ortadogutipdergisi.644329

Öz

Amaç: Bacak ağrısı çocukluk çağında sık görülen bir yakınma olup çocuk romatoloji polikliniklerine sık başvuru nedenlerinden birisidir. Bu çalışmada bacak ağrısı ile çocuk romatoloji polikliniğine başvuran olguların etiyolojilerinin araştırılması ve sık görülen nedenlerin ortaya konması amaçlanmıştır.
Gereç ve Yöntem: Ağustos 2018 ile Ağustos 2019 tarihleri arasında bacak ağrısı nedeniyle çocuk romatoloji polikliniğine başvuran 270 hasta çalışmaya dahil edildi. Hastaların dosyaları geriye dönük olarak incelendi. Hastaların başvuru yakınmaları, demografik, klinik ve laboratuvar verileri önceden hazırlanmış formlara kaydedildi.
Bulgular: Çalışmaya %63’ü (n=170) kız olmak üzere 270 hasta dahil edildi. Hastaların ortalama yaşı ve ortalama yakınma başlama yaşı sırasıyla 10,4 ± 4,8 ve 9,1 ± 3,2 yıl bulundu. Bacak ağrısının en sık sebebi 74 (%27,4) hasta ile hipermobilite sendromuydu. Daha sonra sırasıyla 41 (%15) hastaya büyüme ağrısı, 39 (%14,4) hastaya Osgood-Schlatter hastalığı, 32 (%11,8) hastaya post-enfeksiyöz artrit/artralji, 28 (%10,3) hastaya fibromiyalji, 20 (%7,4) hastaya juvenil idyopatik artrit tanısı konuldu. On (%3,7) hasta akut romatizmal ateş, 2 (%0,74) hasta akut lenfoblastik lösemi tanısı aldı. Yaş grupları değerlendirildiğinde özellikle fibromyalji tanısı alan hastaların hepsi adolesan kız çocuğuydu. Bacak ağrılarının %62,5’i çift taraflıydı. Hastaların %44’ünde gerçekten bacak ağrısı varken diğer hastalarda başvuru yakınması bacak ağrısı olmasına rağmen asıl gösterilen yer bacaklar değil diz ve ayak bilek eklemleriydi.
Sonuç: Çocukluk çağında bacak ağrısı sık karşılaşılan bir yakınma olup sıklıkla hipermobilite sendromu ve büyüme ağrısı gibi inflamatuvar olmayan nedenlere bağlı olarak görülebilmektedir. Çalışmamızda da bacak ağrısının en sık sebebi hipermobilite sendromuydu. Özellikle adolesan dönemde Osgood-Schlatter hastalığı ve fibromiyalji, çocukluk döneminde ise büyüme ağrısı ön planda düşünülmelidir. Bu benign hastalıkların yanında özellikle eklemde şişlik olduğunda juvenil idyopatik artrit ve akut romatizmal ateş gibi hastalıklar da akılda tutulmalıdır. Yine nadir görülen hastalıklardan lösemiler, avasküler nekroz, meniskopatiler de bacak ağrısı ile başvurabilir. Sonuçta çocuklarda bacak ağrısı önemsenmesi gereken bir yakınma olup hastalar iyi sorgulanmalı ve ayırıcı tanı iyi yapılmalıdır.

Kaynakça

  • Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: a review. Pain 1991: 46:247-64.
  • De Inocencio J. Epidemiology of musculoskeletal pain in primary care. Arch Dis Child. 2004; 89:431–4.
  • Gunz AC, Canizares M, Mackay C, Badley EM. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediatric: a population-based study. BMC Musculoskelet Disord 2012; 13:98.
  • Dobbe AM, Gibbons PJ. Common paediatric conditions of the lower limb. J Paediatr Child Health 2017; 53: 1077-85.
  • Doughty RA. Growing pains. Del Med J 1988; 60:641- 4.
  • Champion D, Pathirana S, Flynn C, ve ark. Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome. Eur J Pain 2012;16: 1224-31.
  • Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol 2007; 34:804–9.
  • Pacey V, Tofts L, Adams RD, ve ark. Quality of life prediction in children with joint hypermobility syndrome. J Paediatr Child Health 2015; 51:689–95.
  • Cattalini M, Khubchandani R, Cimaz R. When flexibility is not necessarily a virtue: a review of hypermobility syndromes and chronic or recurrent musculoskeletal pain in children. Pediatr Rheumatol Online J 2015; 13:40.
  • Viswanathan V, Khubchandani RP. Joint hypermobility and growing pains in school children. Clin Exp Rheumatol 2008; 26:962–6.
  • Achar S, Yamanaka J. Apophysitis and Osteochondrosis: Common Causes of Pain in Growing Bones. Am Fam Physician 2019; 99:610-8.
  • Circi E, Atalay Y, Beyzadeoğlu T. Treatment of Osgood-Schlatter disease: review of the literature. Musculoskelet Surg 2017; 101:195-200.
  • Spath M, Stratz T, Neeck G, ve ark. Efficacy and tolerability of intravenous tropisetron in the treatment of fibromyalgia. Scand J Rheumatol 2004; 33:267-70.
  • Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990; 33:160-72.
  • Petersen HA. Leg aches. Pediatr Clin North Am 1977; 24: 731-6.
  • Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973; 32:413-8.
  • Baxter MP, Dulberg C. Growing pains" in childhood--a proposal for treatment. J Pediatr Orthop 1988; 8:402-6.
  • Scheper MC, Engelbert RH, Rameckers EA, ve ark. Children with generalized joint hypermobility and musculoskeletal complaints: state of the art on diagnostics, clinical characteristics, and treatment. Biomed Res Int 2013; 2013:121054.
  • Tobias JH, Deere K, Palmer S, ve ark. Joint hypermobility is a risk factor for musculoskeletal pain during adolescence: findings of a prospective cohort study. Arthritis Rheum 2013; 65:1107-15.
  • Castori M, Morlino S, Celletti C, ve ark. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrom Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet 2013;161A: 2989–3004.
  • Kaspiris A, Zafiropoulou C. Growing pains in children: epidemiological analysis in a Mediterranean population. Joint Bone Spine 2009; 76:486-90.
  • Evans AM, Scutter SD. Are foot posture and functional health different in children with growing pains? Pediatr Int 2007; 49:991-6.
  • Evans AM, Scutter SD, Lang LM, Dansie BR. “Growing pains” in young children: a study of the profile, experiences and quality of life issues of four to six year old children with recurrent leg pain. Foot. 2006; 16:120-4.
  • Vehapoglu A, Turel O, Turkmen S, ve ark. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract 2015; 24:332-8.
  • Evans AM. Relationship between “growing pains” and foot posture in children: single-case experimental designs in clinical practice. J Am Pediatr Med Assoc 2003; 93:111–7.
  • Uziel Y, Hashkes PJ. Growing pains in children. Pediatr Rheumatol Online J 2007; 5:5.

Evaluation of patients presenting with leg pain to the pediatric rheumatology polyclinic: A single center experience

Yıl 2020, Cilt: 12 Sayı: 2, 181 - 185, 01.06.2020
https://doi.org/10.21601/ortadogutipdergisi.644329

Öz

Objective: Leg pain is a common complaint in childhood and is one of the most common causes of admission to pediatric rheumatology outpatient clinics. The aim of this study was to analyze the demographic data and etiology of patients presenting with leg pain and to reveal common causes.
Material and Methods: The files of patients who presented to our pediatric rheumatology outpatient department between August 2018 and August 2019 due to leg pain were retrospectively reviewed. Patient demographic, clinical, and laboratory data were obtained from the patients’ files and hospital database. An information form that collected data on patient gender and current age, age at disease onset, age at diagnosis was completed for all patients.
Results: The study included 270 patients with a mean age of 10.4 ± 4.8 years, including 170 (63%) females and 100 (37%) males. The mean age of onset of complaints was 9.1 ± 3.2 years. The most common cause of leg pain was hypermobility syndrome with 74 (27.4%) patients. Respectively, 41 (15%) patients were diagnosed with growing pain, 39 (14,4%) patients with Osgood-Schlatter disease, 32 (11,8%) patients with post-infectious arthritis / arthralgia, 28 (10,3%) patients with fibromyalgia, 20 (7,4%) patients with juvenile idiopathic arthritis. Two patients had acute lymphoblastic leukemia and 10 patients had acute rheumatic fever. All patients with fibromyalgia were girls and adolescents. 62.5% of leg pain was bilateral. 44% of patients really had leg pain. Although the complaint of presentation in other patients was leg pain, it was not the legs but the localized knee and ankles.
Conclusion: Leg pain is a common complaint both in childhood and adolescence. Hypermobility syndrome was the most common cause in both periods. Osgood-Schlatter disease and fibromyalgia should be considered especially in adolescence and growing pain in childhood. In addition to these benign diseases, diseases such as juvenile idiopathic arthritis and acute rheumatic fever should be considered, especially when the joint is swollen. Leukemia’s, avascular necrosis and meniscopathies may also present with leg pain. As a result, leg pain in children is a complaint that should be considered and patients should be questioned well and differential diagnosis should be made well.

Kaynakça

  • Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: a review. Pain 1991: 46:247-64.
  • De Inocencio J. Epidemiology of musculoskeletal pain in primary care. Arch Dis Child. 2004; 89:431–4.
  • Gunz AC, Canizares M, Mackay C, Badley EM. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediatric: a population-based study. BMC Musculoskelet Disord 2012; 13:98.
  • Dobbe AM, Gibbons PJ. Common paediatric conditions of the lower limb. J Paediatr Child Health 2017; 53: 1077-85.
  • Doughty RA. Growing pains. Del Med J 1988; 60:641- 4.
  • Champion D, Pathirana S, Flynn C, ve ark. Growing pains: twin family study evidence for genetic susceptibility and a genetic relationship with restless legs syndrome. Eur J Pain 2012;16: 1224-31.
  • Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol 2007; 34:804–9.
  • Pacey V, Tofts L, Adams RD, ve ark. Quality of life prediction in children with joint hypermobility syndrome. J Paediatr Child Health 2015; 51:689–95.
  • Cattalini M, Khubchandani R, Cimaz R. When flexibility is not necessarily a virtue: a review of hypermobility syndromes and chronic or recurrent musculoskeletal pain in children. Pediatr Rheumatol Online J 2015; 13:40.
  • Viswanathan V, Khubchandani RP. Joint hypermobility and growing pains in school children. Clin Exp Rheumatol 2008; 26:962–6.
  • Achar S, Yamanaka J. Apophysitis and Osteochondrosis: Common Causes of Pain in Growing Bones. Am Fam Physician 2019; 99:610-8.
  • Circi E, Atalay Y, Beyzadeoğlu T. Treatment of Osgood-Schlatter disease: review of the literature. Musculoskelet Surg 2017; 101:195-200.
  • Spath M, Stratz T, Neeck G, ve ark. Efficacy and tolerability of intravenous tropisetron in the treatment of fibromyalgia. Scand J Rheumatol 2004; 33:267-70.
  • Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990; 33:160-72.
  • Petersen HA. Leg aches. Pediatr Clin North Am 1977; 24: 731-6.
  • Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973; 32:413-8.
  • Baxter MP, Dulberg C. Growing pains" in childhood--a proposal for treatment. J Pediatr Orthop 1988; 8:402-6.
  • Scheper MC, Engelbert RH, Rameckers EA, ve ark. Children with generalized joint hypermobility and musculoskeletal complaints: state of the art on diagnostics, clinical characteristics, and treatment. Biomed Res Int 2013; 2013:121054.
  • Tobias JH, Deere K, Palmer S, ve ark. Joint hypermobility is a risk factor for musculoskeletal pain during adolescence: findings of a prospective cohort study. Arthritis Rheum 2013; 65:1107-15.
  • Castori M, Morlino S, Celletti C, ve ark. Re-writing the natural history of pain and related symptoms in the joint hypermobility syndrom Ehlers-Danlos syndrome, hypermobility type. Am J Med Genet 2013;161A: 2989–3004.
  • Kaspiris A, Zafiropoulou C. Growing pains in children: epidemiological analysis in a Mediterranean population. Joint Bone Spine 2009; 76:486-90.
  • Evans AM, Scutter SD. Are foot posture and functional health different in children with growing pains? Pediatr Int 2007; 49:991-6.
  • Evans AM, Scutter SD, Lang LM, Dansie BR. “Growing pains” in young children: a study of the profile, experiences and quality of life issues of four to six year old children with recurrent leg pain. Foot. 2006; 16:120-4.
  • Vehapoglu A, Turel O, Turkmen S, ve ark. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract 2015; 24:332-8.
  • Evans AM. Relationship between “growing pains” and foot posture in children: single-case experimental designs in clinical practice. J Am Pediatr Med Assoc 2003; 93:111–7.
  • Uziel Y, Hashkes PJ. Growing pains in children. Pediatr Rheumatol Online J 2007; 5:5.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Semanur Özdel 0000-0001-5602-4595

Esra Bağlan 0000-0001-5637-8553

Mehmet Bülbül 0000-0001-9007-9653

Yayımlanma Tarihi 1 Haziran 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 12 Sayı: 2

Kaynak Göster

Vancouver Özdel S, Bağlan E, Bülbül M. Çocuk romatoloji polikliğine bacak ağrısı nedeni ile başvuran hastaların değerlendirilmesi: Tek merkez deneyimi. otd. 12(2):181-5.

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