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Abstract Back pain is common in children and adolescents. Most cases of back pain are non-specific and self-limiting. In children and adolescents, pain is usually related to the posterior elements of the spine and disc-related problems are rare. Serious pathology, including malignancy and infection needs to be excluded. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the immature skeleton. Diagnostic imaging is useful in the evaluation of a child or adolescent with low back pain and can help guide management. This article will review common causes of back pain in the pediatric population.

Abstract We report a case of a 5-year old girl, who initially presented with acute epiglottitis, sepsis and multi-organ failure. She was subsequently diagnosed as having Systemic Lupus Erythematosus. To the best of our knowledge, this article describes the first case of Haemophilus influenzae type f epiglottitis as the initial presentation of SLE in childhood.

Abstract Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population.

Abstract Foot and ankle pain is common in children and adolescents. Problems are usually related to skeletal maturity and are fairly specific to the age of the child. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of foot and ankle pain in the pediatric population.

Abstract Anterior knee pain is common in children and adolescents. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of chronic anterior knee pain in the pediatric population with a focus on patellofemoral pain.

Background: Physical activity (PA) patterns in children with juvenile idiopathic arthritis (JIA) over time are not well described. The aim of this study was to describe associations of physical activity (PA) with disease activity, function, pain, and psychosocial stress in the 2 years following diagnosis in an inception cohort of children with juvenile idiopathic arthritis (JIA). Methods: In 82 children with newly diagnosed JIA, PA levels, prospectively determined at enrollment, 12 and 24 months using the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) raw scores, were evaluated in relation to disease activity as reflected by arthritis activity (Juvenile Arthritis Disease Activity Score (JADAS-71)), function, pain, and psychosocial stresses using a linear mixed model approach. Results in the JIA cohort were compared to normative Pediatric Bone Mineral Accrual Study data derived from healthy children using z-scores. Results: At enrollment, PA z-score levels of study participants were lower than those in the normative population (median z-score − 0.356; p = 0.005). At enrollment, PA raw scores were negatively associated with the psychosocial domain of the Juvenile Arthritis Quality of Life Questionnaire (r = − 0.251; p = 0.023). There was a significant decline in PAQ-C/A raw scores from baseline (median and IQR: 2.6, 1.4–3.1) to 24 months (median and IQR: 2.1, 1.4–2.7; p = 0.003). The linear mixed-effect model showed that PAQ-C/A raw scores in children with JIA decreased as age, disease duration, and ESR increased. The PAQ-C/A raw scores of the participants was also negatively influenced by an increase in disease activity as measured by the JADAS-71 (p < 0.001). Conclusion: Canadian children with newly diagnosed JIA have lower PA levels than healthy children. The decline in PA levels over time was associated with disease activity and higher disease-specific psychosocial stress. [ABSTRACT FROM AUTHOR]

Back pain is common in children and adolescents. Most cases of back pain are non-specific and self-limiting. In children and adolescents, pain is usually related to the posterior elements of the spine and disc-related problems are rare. Serious pathology, including malignancy and infection needs to be excluded. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the immature skeleton. Diagnostic imaging is useful in the evaluation of a child or adolescent with low back pain and can help guide management. This article will review common causes of back pain in the pediatric population. [ABSTRACT FROM AUTHOR]

Foot and ankle pain is common in children and adolescents. Problems are usually related to skeletal maturity and are fairly specific to the age of the child. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of foot and ankle pain in the pediatric population. [ABSTRACT FROM AUTHOR]

Background/Purpose: Although children with JIA have lower fitness levels than healthy peers, little is known about their level of habitual physical activity. The LEAP study is a prospective longitudinal multicentre study of children and teens with JIA, aimed at describing the trajectory of physical activity (PA) in JIA, and its relationship to disease factors, inflammation, quality of life, bone health and muscle function. We report PA levels of children with JIA in early and late disease at study entry. Methods: We enrolled patients with JIA (aged 8-16 y) at 12 pediatric rheumatology centres in Canada as either an inception cohort (early disease; within 6 mos of diagnosis) or an established disease cohort (late disease; > 2yr after diagnosis). We assessed PA with a validated Physical Activity Questionnaire for children (PAQ-C, age 8-13 y) or teens (PAQ-A, age 14-16 y). This 7-day recall self-report tool has scores from 0 (no PA)- 5(high PA). Participants record weekly PA across a wide range of activities and sports. Patients completed a pain scale (VAS 0-100), the Childhood Health Assessment Questionnaire (CHAQ), and Juvenile Arthritis Quality of life Questionnaire (JAQQ). Examining physicians recorded physician global assessment of disease activity (PGA;VAS 0-100) and active joint count. We used univariate and multivariate regression (controlled for gender) to examine relationships between disease and patient factors and PAQ score at study entry. We used PAQ standard population normative values to compare to subjects (female 2.69, SD 0.62; male 3.0 SD 0.72). Results: We included the first 189 patients enrolled (126 F, 63 M, med age 13 y) from March 2012-November 2013. The early cohort included 81 patients (enrolled median 2.4 mo after diagnosis) and the late cohort included 108 patients (enrolled median 4.8 yr after diagnosis). Active arthritis was found in 88 patients, with a mean of 5.5 active joints (range 1-56). PGA was a mean of 13.45 (range 0-74). Overall mean PAQ score for the JIA patients was 2.55 (SD 0.73, range 1-4). Table describes PAQ scores by sex, disease cohort, and presence of active arthritis. When controlled for sex, PAQ scores were significantly different between new onset and late disease, and between patients with active arthritis compared with no active arthritis. Univariate analyses revealed that higher PAQ score were associated with lower pain (p = 0.02), lower CHAQ score (p < 0.0001), higher JAQQ score (p = 0.0001), lower active joints (p = 0.002) and low PGA (p = 0.003). Multivariate analysis confirmed these associations, with R2 = 0.25, p = 0.000 (girls), R2 = 0.17, p = 0.01 (boys). [ABSTRACT FROM AUTHOR]

Le hockey est l'un des sports les plus populaires auprès des enfants et adolescents canadiens. Les avantages de l'activité physique et de la participation à des activités sportives pour la santé sont bien établis, mais on s'inquiète de plus en plus de la fréquence et de la gravité des blessures liées au hockey, notamment les commotions. Les études déterminent constamment que la mise en échec est le principal mécanisme associé aux blessures, y compris les commotions, chez les jeunes hockeyeurs. Les politiques pour retarder la mise en échec jusqu'aux ligues bantams (lorsque les participants ont de 13 à 14 ans) réduiront les risques de blessures et de commotions chez les jeunes hockeyeurs. Il faudrait éliminer la mise en échec au hockey non élite et réévaluer l'âge auquel l'autoriser au hockey compétitif. Ces deux initiatives exigent des changements de politiques dans bien des provinces et des territoires et doivent être réévaluées de manière prospective à la lumière des recherches émergentes. [ABSTRACT FROM AUTHOR]

Objective: Currently there are no evidence-based recommendations regarding fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies (IIM). This hinders clinicians and researchers in choosing the appropriate fitness- or muscle strength-related outcome measures for these patients. Through a Delphi survey, we aimed to identify a candidate core set of fitness and strength tests for children and adults with IIM., Methods: Fifteen experts participated in a Delphi survey that consisted of 5 stages to achieve a consensus. Using an extensive search of published literature and through the work of experts, a candidate core set based on expert opinion and clinimetrics properties was developed. Members of the International Myositis Assessment and Clinical Studies Group were invited to review this candidate core set during the final stage, which led to a final candidate core set., Results: A core set of fitness- and strength-related outcome measures was identified for children and adults with IIM. For both children and adults, different tests were identified and selected for maximal aerobic fitness, submaximal aerobic fitness, anaerobic fitness, muscle strength tests, and muscle function tests., Conclusion: The core set of fitness- and strength-related outcome measures provided by this expert consensus process will assist practitioners and researchers in deciding which tests to use in patients with IIM. This will improve the uniformity of fitness and strength tests across studies, thereby facilitating the comparison of study results and therapeutic exercise program outcomes among patients with IIM.

Objective: To compare the estimated prevalence and the phenotype of pediatric systemic lupus erythematosus (SLE) in a North American Native population with other ethnic groups., Methods: We performed a retrospective chart review of all patients with SLE currently followed at the single tertiary care pediatric rheumatology clinic in our province. Data collected included demographic characteristics, family history, classification criteria for SLE, laboratory tests at diagnosis, SLE Disease Activity Index (SLEDAI) at presentation, and Systemic Lupus International Collaborating Clinics (SLICC) damage index at 6 months., Results: The prevalence of SLE in our pediatric Native population is 8.8 per 100,000 (n = 6) compared to 3.3 per 100,000 in the non-NAI population (n = 34) (p = 0.037, Fisher's exact test; OR 2.6, 95% CI 1.1-6.3). Family history of rheumatic disease is more common in our Native children (5/6, 83%) compared to non-Native children (5/34, 15%) (p = 0.002 Fisher's exact test; OR 29, 95% CI 2.8-303.3). The sample size is too small for reliable interpretation of disease phenotype, autoantibodies, disease activity, and disease damage measures., Conclusion: There is an increased prevalence of SLE and familial autoimmunity among Native children in our population. Public health measures to screen children at risk may detect early disease and may reduce disease morbidity.

Primary Sjögren's syndrome (pSS) is uncommonly recognized in childhood, and familial cases are rare. Pulmonary involvement in pediatric pSS is infrequently reported. In adults, asymptomatic pulmonary involvement is increasingly recognized, manifest by pulmonary function test abnormalities and changes on high resolution computerized tomographic scan. We describe a case of pSS in a 14-year-old Vietnamese-Canadian girl who presented with pulmonary symptoms, radiologic changes, and biopsy confirmation of lymphocytic interstitial pneumonia. Her dizygotic twin sister has primary SS without extraglandular manifestations. To our knowledge this is the first report of pediatric pSS with lymphocytic interstitial pneumonia and multiple pulmonary nodules on chest radiograph. We review the literature on pulmonary involvement and familial cases of pSS in childhood.