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11 year old girl with joint pain
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11 year old girl with joint pain

My 11 year old daughter has been having headaches and joint pain for several months.  The  joint pain travels around.  One day it is her fingers or thumb that hurt and another day it may be her elbow, wrist, knee, ankle or even hip that hurt.  Her tibia's also hurt and are tender to the touch.  The headaches range in frequency from 2-5 times per week.  She has also had three episodes of petechial hemorrhages.  Once in her eyelid (just woke up with it), once around a mosquito bite, and once after playing volleyball (both forearms were covered with petechial hemorrhages).  She also had a positive ANA back in April '09.  Her CBC, Chem panel were unremarkable.  Pediatrician sent her to a rheumatologist back in April but he said her joint pain was because her joints were a tad loose.  He also tried to explain away her headaches (anxiety) and the petechial hem. (must have scratched the mosquito bite - but I don't buy it.  she had many other bites too and scratched them all a little but only that one had the hem. The volleyball hem. occurred after we saw him)  He also dismissed the positive ANA and refused to do any more lab work.  Her symptoms persist and her doctor refuses to look into her having something like Lyme or bartonella.  He said Lyme is a slippery slope and we shouldn't go down that path.  I am very frustrated and want to be an advocate for my daughter but no one will listen.  Please give advice.

frustrated,
Manette
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If the ANA test result comes back above the normal range the test is said to be positive. A positive ANA test by itself is not proof of lupus, A positive ANA test result may suggest an autoimmune disease, but further specific ... A positive ANA can also mean that the patient has drug-induced lupus.
Other laboratory tests associated with presence of inflammation, such as erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) may also be ordered. Did your other blood tests cover this?
Two subset tests for specific types of autoantibodies, such as anti-dsDNA and anti-SM, may be ordered to rule out SLE.
We would advice you to follow up with other tests to rule out any other auto immune disoder as she also has the symptoms of arthritis, rash, petechial haemorrhages and ANA positive.
Follow up in a good paediatric facility.
it may be worthwhile to repeat the ANA test at a future date.

Juvenile Rheumatoid arthritis/ Juvenile idiopathic arthritis/ Lyme disease/ Bartonella should only be suspected with worsening of the symptoms and only afer she is negative with any auto immune disorder. Do recollect any symptoms of fever or infection before these symptoms of hers. Why we do not suspect Lyme's as Erythema migrans is thought to occur in about 80% of infected patients Patients can also experience flu-like symptoms such as headache, muscle soreness, fever, and malaise whcih did not occur with your child.


Take care and follow up with the tests and come back to us for further queries.


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