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In this focused and highly educational webinar, Prof. Athimalaipet Ramanan, a leading pediatric rheumatologist in the UK, addresses the complexities of diagnosing juvenile idiopathic arthritis (JIA) and distinguishing it from other conditions that mimic its presentation. The session is designed to equip pediatricians and general practitioners with the practical knowledge needed to avoid delays in diagnosis and improve early management.
Prof. Ramanan begins with a clinical case of a three-year-old boy presenting with persistent right knee swelling for a month. He explains how this seemingly straightforward complaint must be interpreted with clinical precision—emphasizing the importance of age, duration of symptoms, and monoarticular involvement as red flags. He notes that transient synovitis or trauma is often suspected, but misattributing symptoms to minor injuries or growing pains can delay critical intervention.
A significant part of the session is devoted to physical examination techniques. Ramanan underscores the need to examine joints from both anterior and posterior views, properly undress the child, and consider subtle signs like suprapatellar effusion and loculated swelling. He uses visual examples to illustrate how wrist or ankle swelling can be missed without a thorough and practiced approach.
The discussion also explores the limitations of laboratory investigations. Prof. Ramanan cautions against over-reliance on inflammatory markers and autoimmune tests such as antinuclear antibodies (ANA), which often produce false positives in children and should only be used with clear clinical justification. He differentiates JIA from conditions like lupus, dermatomyositis, and systemic sclerosis, where ANA may have diagnostic value.
A key message of the presentation is the importance of recognizing “preferred pain,” where the site of discomfort reported by the child may not match the joint actually affected. He outlines common misdiagnoses, including malignancies, infections, and storage disorders such as mucopolysaccharidoses, which can resemble arthritis in their early stages. Ramanan warns clinicians to consider leukemia in any child with unexplained musculoskeletal symptoms, as it can present solely with joint pain.
The session concludes with practical takeaways: suspect JIA when joint swelling persists beyond six weeks; avoid premature testing; and prioritize clinical judgment over routine lab panels. Above all, he urges clinicians to develop confidence in joint examination and to maintain a high index of suspicion for rheumatologic and mimicking conditions in pediatric patients.