Questions for Discussion:

  1. What are your diagnostic considerations at this time?  Answer

  2. What questions do you need to ask to narrow the differential diagnosis? Answer

The patient has been previously healthy but did experience low-grade fever, malaise, and myalgias about two weeks ago. This lasted 2-3 days and resolved without specific therapy. Many children in her class have been absent over the last few weeks.

Her review of systems is otherwise negative except for fatigue. She takes no medications.

PE: Afebrile
       No rash

Joints: Tenderness and mild swelling in the wrists and PIP joints, knees and MTP bilaterally.

General exam is unremarkable

  1. What do you think are the most likely causes of joint pain now?  Answer
  2. What diagnostic tests should be considered?  Answer
  3. How do you treat the patient?  Answer

Laboratory tests are all normal and the patient responds well to treatment. Over the next 6-8 weeks her symptoms completely resolve.

  1. What do you conclude now?  Answer