Chronic arthritis in adolescence

Musculoskeletal complaints, and joint pain in particular, are common symptoms among adolescents presenting to primary care providers. In this article, the distinction between arthralgia and arthritis is described, and important inflammatory arthropathies seen in teenagers are addressed. The current nomenclature of juvenile idiopathic arthritis is used to address each of the major clinical entities that account for chronic arthritis in teens, including oligoarthritis, polyarthritis, systemic arthritis, psoriatic arthritis, and spondyloarthropathy. Diagnostic criteria, important comorbidities, and principles of management are summarized with identification of antiinflammatory, immunosuppressive, and cytokine-specific biological agents and their relative uses. Other categories of chronic arthritis are also discussed, including infection-associated reactive arthritis, Lyme disease, joint disease of inflammatory bowel disease, as well as chronic arthritis as a dimension of other autoimmune diseases. In addition to the biomedical dimension of these disorders, the psychological impact and developmental context of persistent pain and musculoskeletal abnormality in adolescents are commented on.