Joint Pain: Insights on Juvenile Spondyloarthritis

Joint pain issues

Hello, doctor.
I just learned about this website today and looked into the content regarding juvenile ankylosing spondylitis.
I feel that some aspects resonate with my experience, and I hope you can provide me with some guidance.

When I was in the third year of junior high, around 15 or 16 years old, I suddenly experienced severe pain in my left knee during a mock exam around 3 PM.
The pain was so intense that I clenched my teeth, broke out in a cold sweat, and turned pale.
Initially, I found some relief by keeping my leg straight, but the pain worsened, making it impossible to sit, stand, or walk.
By evening, I couldn't even lie down to sleep.
That day, my mother took me to a small clinic specializing in neurology, where I was diagnosed with patellar chondromalacia and prescribed corticosteroids.
Although they provided some relief, the pain remained severe.
This episode lasted for over a week, and from that point until the end of junior high and into high school, I experienced pain at least once a month, lasting at least a week each time, though there was no fixed schedule for the pain.
In the second year of high school, I began to experience pain in my right knee as well, though it was not as severe as during junior high.
From my second to third year of high school, I also had pain in my ankles and the soles of my feet.
Sometimes, both my left and right knees, along with my ankles and the soles of my feet, would hurt simultaneously.
Throughout high school, I visited large hospitals for examinations, primarily seeing orthopedic specialists.
They performed X-rays, and some noted swelling in my knee joints or attributed the pain in my ankles and soles to tendonitis.
By the time I reached my third year of high school, I continued to experience pain in both knees, ankles, and the soles of my feet, but I also began to feel stiffness and pain in the area just above my buttocks, which I believe is related to the sacrum.
This pain lasted for a month, and for the first two weeks, it was so severe that I struggled to get out of bed quickly in the morning and had to adjust my position slowly.
During class, I could only alternate between sitting and standing, as sitting would cause unbearable pain in my buttocks and sacrum.
Eventually, I couldn't tolerate it any longer and went to a large hospital to see a neurologist.
They conducted blood tests for rheumatism but found no Rh factor.
An electromyography test also came back normal, and the MRI results were normal as well.
The doctor could only prescribe painkillers, but I am hesitant to take them frequently due to concerns about their effects on my body.

Now, I occasionally experience tingling and numbness in my left leg, and I worry that it might be sciatica or a bone spur, which frightens me.
Please provide your insights!

Xiao Zhuo, 10~19 year old female. Ask Date: 2012/11/20

Dr. Zeng Guosen reply Internal Medicine

Hello, based on your description, if you are experiencing joint pain along with swelling in the affected joint, it indicates the presence of a rheumatic disease.
Sciatica or bone spurs would not typically cause joint swelling and pain.
I recommend that you visit a nearby rheumatology clinic for evaluation, as it will likely be beneficial.
Thank you for your inquiry.

Reply Date: 2012/11/20

More Info

Juvenile spondyloarthritis (JSpA) is a type of inflammatory arthritis that affects children and adolescents, often leading to joint pain and stiffness. Your experience with recurrent knee pain, particularly during your teenage years, raises several important considerations regarding the diagnosis and management of potential juvenile spondyloarthritis or related conditions.

From your description, it appears that you experienced significant pain in your left knee during a stressful situation, which later progressed to involve both knees, ankles, and even the lower back. This pattern of joint pain, particularly if it is associated with morning stiffness and improved with activity, is characteristic of inflammatory arthritis. The fact that your pain has persisted over time and has involved multiple joints suggests that there may be an underlying inflammatory process at play.

The diagnosis of juvenile spondyloarthritis can be challenging, especially in the absence of definitive laboratory findings such as the presence of rheumatoid factor or specific imaging results. However, the symptoms you describe—recurring joint pain, stiffness, and the involvement of both large joints (knees) and axial joints (lower back)—are consistent with this condition. Additionally, the fact that you have experienced episodes of pain that last for weeks and are associated with significant discomfort during rest could indicate an inflammatory arthritis rather than a mechanical issue.

In terms of management, it is essential to work closely with a rheumatologist who specializes in pediatric cases. They can provide a comprehensive evaluation, including a detailed history, physical examination, and possibly further imaging studies or laboratory tests to assess for inflammation and rule out other conditions. Early diagnosis and treatment are crucial in managing juvenile spondyloarthritis effectively to prevent long-term joint damage and improve quality of life.

Treatment options for juvenile spondyloarthritis typically include nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage pain and inflammation. In some cases, disease-modifying antirheumatic drugs (DMARDs) or biologic therapies may be necessary, especially if the disease is severe or does not respond to NSAIDs alone. Physical therapy can also play a vital role in maintaining joint function and mobility.

It is understandable to have concerns about the long-term implications of your symptoms, especially with the fear of conditions like sciatica or bone spurs. However, it is essential to focus on obtaining a clear diagnosis first. Regular follow-ups with your healthcare provider, adherence to prescribed treatments, and open communication about your symptoms will be key in managing your condition effectively.

In summary, your symptoms warrant a thorough evaluation for juvenile spondyloarthritis or a related inflammatory condition. Engaging with a specialist in pediatric rheumatology will be beneficial in obtaining an accurate diagnosis and appropriate treatment plan. Remember, early intervention can significantly impact the course of the disease and your overall well-being.

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