Eklem Ağrısı İle Başvuran Çocuklarınretrospektif Değerlendirilmesi.
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Tarih
2022
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Artralji eklem ağrısı ile beraberinde inflamatuar belirteçlerin olmadığı, artrit ise eklem ağrısının yanında eklemde şişlik, kızarıklık, ısı artışı ve hareket kısıtlılığından en az birisinin eşlik ettiği yangısal duruma denilir. Eklem ağrısı çocuklarda sık görülen semptomdur ve çok farklı hastalıkların bulgusu olabilir. Çalışmamızın amacı artralji ile başvuran çocuklarda etyolojiyi araştırmak ve kategorize etmek, demografik özelliklerini, hastaların başvuru yerlerine göre dağılımını, en sık başvuru şikayetlerini, başvurduğu bölüme göre yönlendirilen bölümleri tespit etmek ve bu hastaların son durumunu belirlemekti. Ayrıca içinde bulunduğumuz Covid-19 pandemisinin eklem ağrısı ile ilişkisini incelemekti.
Çalışmamızda Ocak 2020- Aralık 2021 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı çocuk genel ve yandal (nefroloji, enfeksiyon, hematoloji/onkoloji, acil) polikliniklerine eklem ağrısı ile başvuran hastalar geriye dönük incelendi. Hastaların başvuru şikayetleri, fizik muayeneleri, laboratuvar tetkikleri, radyolojik görüntülemeleri ve sonuç durumu değerlendirildi. İstatistiksel analizler için SPSS 23.0 programı kullanıldı. p <0,05 olması anlamlı kabul edildi. Çalışmaya dahil edilen 293 hastanın yaş ortalaması 125,9±51,3 ay, ortancası 132 (16-210) aydır. Hastalar ana tanı gruplarına göre sınıflandırıldığında yaş bakımından istatiksel olarak anlamlı bir fark saptanmamıştır (p=0,14). Hastaların % 52,9 erkek (n=155), %47,1(n=138)’i kız ve erkek/kız oranı 1/ 1,2 saptandı. Tanı gruplarına göre sınıflandırılarak cinsiyetlerine göre karşılaştırıldığında cinsiyetler bakımından istatistiksel olarak anlamlı bir fark saptanmıştır (p=0,013). Çalışmamızda 293 hastanın 163’ünde (% 55,6) artrit, 130’unda (% 44,3) artralji
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saptanmıştır. Tanı grupları arasında artrit-artralji varlığı bakımından istatistiksel olarak anlamlı bir fark saptanmıştır (p<0,001). Enfeksiyöz (% 66,3) ve inflamatuar (%85,5) grupta artrit oranı belirgin yüksektir. Hastalarımızda tanı olarak en sık bruselloz % 11, 9 (n= 35) ikinci sıklıkla reaktif artrit % 8,8 (n=26) ve üçüncü sıklıkla juvenil idyopatik artrit % 8,5 (n=25) tanısı konulmuştur. Ayrıca hastaların %8,2’ine Henoch-Sconlein purpurası, %6,1’ine raşitizm/D vitamini eksikliği, %5,1’ine viral artrit, %4,4’üne travma, %4,1’ine akut lösemi tanısı konulmuştur. Çalışmamızda olgular incelendiğinde en sık tutulan eklemler sırasıyla diz (%60,1), ayak bileği (%38,5), dirsek (% 11,9) saptanmıştır. Dizde artralji ile başvuran hastada en olası tanı juvenil idyopatik artrit, ayak bileğinde en olası tanı Henoch-Sconlein purpurası, kalçada artralji ile başvuran hastada en olası tanı brucelloz saptanmıştır. Hasta grupları arasında trombosit sayısı (p<0,001), eritrosit sedimantasyon hızı değeri (p<0,001) ve lökosit sayısı bakımından istatistiksel olarak anlamlı fark saptanmıştır (p<0,001). C-reaktif protein değerindeki artış istatiksel olarak anlamlı değildi. (p>0,005) Artrit ile başvuranlarda artraljiye oranla lökositoz ve eritrosit sedimantasyon hızı yüksekliği anlamlı derecede yüksek oranda saptanmıştır.
Sonuç olarak; eklem ağrısı şikayeti çocuklarda sık görülen ve çok farklı sonuç tanıları alabilen bir durumdur. Şikayetin başlama zamanı, hangi eklemlerin tutulduğu, ek şikayet varlığı, fizik muayene özellikleri, ek semptomları, aile öyküsü, travma, çiğ sütten süt ve süt ürünleri tüketimi ve bazı laboratuvar parametreleri ile görüntüleme teknikleri ayırıcı tanıda yol gösterici olabilir. Çocuklarda artraljilerin büyük çoğunluğu akut başlar ve enfeksiyon ile ilişkilidir. Çalışmamızda eklem ağrısı ile başvuran hastalarda en sık görülen tanı bruselloz olmuştur. Brusellanın yüksek oranda olması Konya ve çevresindeki illerde çiğ süt ve süt ürünleri ile beslenme ve hayvancılıkla uğraşmanın yaygın olması ile ilişkilidir. Eklem ağrısı, ateş, iştahsızlık, halsizlik gibi non spesifik şikayetlerle başvurduğundan birçok hastalıkla ayırıcı tanıya girer. Ülkemiz ve bölgemiz gibi halen yoğun brusella görülen bölgelerde ayırıcı tanıda akılda mutlaka bulundurulmalıdır ve pastörize süt ve ürünleri kullanılması teşvik edilmelidir.
Arthralgia is defined as a condition in which the joint pain is not accompanied by inflammatory markers. Arthritis is, however, defined as the inflammatory condition in which the joint pain is accompanied by at least one of swollen joints, redness, warm joints and limited range of motion. Joint pain is a common symptom among children and observed in many different diseases. The objective of our study is investigating etiology and retrospective evaluation of demographic data of children presenting with arthralgia.In our study, patients presenting with joint pain to General Pediatrics and Pediatric Subspecialty (Nephrology, Infectious Diseases, Hematology/Oncology and Emergency Department) Outpatient Clinics of Necmettin Erbakan University Meram Faculty of Medicine Department of Pediatrics between January 2020 and December 2021 were evaluated retrospectively. Patients’ presenting complaints, physical examination findings, laboratory results, radiological studies and outcome were evaluated. SPSS 23.0 package program was used for statistical analyses. A p<0.05 was considered significant. Of 293 patients included in the study; mean age was 125.9±51.3 months, with a median of 132 (16-210) months. No statistically significant difference in age was determined when the patients were classified according to major diagnostic groups (p=0.14).Of the patients; 52.9% (n=155) were male and 47.1% (n=138) female, with a male/female ratio of 1/1.2.A statistically significant difference in gender was observed when they were classified according to the diagnostic groups (p=0.013). Of 293 patients in our study; 163 (55.6%) were found to have arthritis and 130 (44.3%) arthralgia.A statistically significant difference was determined between the diagnostic groups in terms of presence of arthritis-arthralgia (p<0.001). The rate of arthritis was significantly higher in the vii infectious (66.3%) and inflammatory (85.5%) groups. The most common diagnosis established was brucellosis with a frequency of 11.9% (n=35), followed by reactive arthritis with 8.8% (n=26) and juvenile idiopathic arthritis 8.5% (n=25). Furthermore, of the patients; 8.2% were diagnosed with Henoch Schönlein purpura, 6.1% with rickets/Vitamin D deficiency, 5.1% with viral arthritis, 4.4% with trauma, and 4.1% with acute leukemia. Among the cases in our study, the most commonly involved joints, in descending order, were found to be knees (60.1%), ankles (38.5%) and elbows (11.9). The most likely diagnosis was determined to be juvenile idiopathic arthritis, Henoch Schönlein purpura and brucellosis in patients presenting with arthralgia of knees, ankles and hips, respectively. A statistically significant difference was determined between the patient groups in terms of thrombocyte count (p<0.001), erythrocyte sedimentation rate value (p<0.001), and leukocyte count (p<0,001). The increase in C-reactive protein was statistically insignificant (p>0.005) Rate of leukocytosis and elevated erythrocyte sedimentation rate was found to be significantly higher in patients presenting with arthritis than those presenting with arthralgia.In conclusion, joint pain is a condition which is common among children and may be associated with many different final diagnoses. Time of onset of complaints, which joints are involved, presence of additional complaints, physical examination findings, additional symptoms, family history, trauma, and consumption of dairy products from raw milk, as well as some laboratory parameters and imaging modalities may serve as a guide in differential diagnosis. In children, arthralgias mostly have an acute onset and are associated with infections. In our study, the most common diagnosis in patients presenting with joint pain was brucella. This high rate of brucellosis is related to high rate of consumption of raw dairy products and stockbreeding in Konya and surroundings. Joint pain is included in differential diagnosis of many diseases due to nonspecific presenting complaints including fever, loss of appetite and malaise. Brucellosis should be considered in differential diagnosis and consumption of pasteurized dairy products should be encouraged in our country and the places where brucella is still prevalent like our region.
Arthralgia is defined as a condition in which the joint pain is not accompanied by inflammatory markers. Arthritis is, however, defined as the inflammatory condition in which the joint pain is accompanied by at least one of swollen joints, redness, warm joints and limited range of motion. Joint pain is a common symptom among children and observed in many different diseases. The objective of our study is investigating etiology and retrospective evaluation of demographic data of children presenting with arthralgia.In our study, patients presenting with joint pain to General Pediatrics and Pediatric Subspecialty (Nephrology, Infectious Diseases, Hematology/Oncology and Emergency Department) Outpatient Clinics of Necmettin Erbakan University Meram Faculty of Medicine Department of Pediatrics between January 2020 and December 2021 were evaluated retrospectively. Patients’ presenting complaints, physical examination findings, laboratory results, radiological studies and outcome were evaluated. SPSS 23.0 package program was used for statistical analyses. A p<0.05 was considered significant. Of 293 patients included in the study; mean age was 125.9±51.3 months, with a median of 132 (16-210) months. No statistically significant difference in age was determined when the patients were classified according to major diagnostic groups (p=0.14).Of the patients; 52.9% (n=155) were male and 47.1% (n=138) female, with a male/female ratio of 1/1.2.A statistically significant difference in gender was observed when they were classified according to the diagnostic groups (p=0.013). Of 293 patients in our study; 163 (55.6%) were found to have arthritis and 130 (44.3%) arthralgia.A statistically significant difference was determined between the diagnostic groups in terms of presence of arthritis-arthralgia (p<0.001). The rate of arthritis was significantly higher in the vii infectious (66.3%) and inflammatory (85.5%) groups. The most common diagnosis established was brucellosis with a frequency of 11.9% (n=35), followed by reactive arthritis with 8.8% (n=26) and juvenile idiopathic arthritis 8.5% (n=25). Furthermore, of the patients; 8.2% were diagnosed with Henoch Schönlein purpura, 6.1% with rickets/Vitamin D deficiency, 5.1% with viral arthritis, 4.4% with trauma, and 4.1% with acute leukemia. Among the cases in our study, the most commonly involved joints, in descending order, were found to be knees (60.1%), ankles (38.5%) and elbows (11.9). The most likely diagnosis was determined to be juvenile idiopathic arthritis, Henoch Schönlein purpura and brucellosis in patients presenting with arthralgia of knees, ankles and hips, respectively. A statistically significant difference was determined between the patient groups in terms of thrombocyte count (p<0.001), erythrocyte sedimentation rate value (p<0.001), and leukocyte count (p<0,001). The increase in C-reactive protein was statistically insignificant (p>0.005) Rate of leukocytosis and elevated erythrocyte sedimentation rate was found to be significantly higher in patients presenting with arthritis than those presenting with arthralgia.In conclusion, joint pain is a condition which is common among children and may be associated with many different final diagnoses. Time of onset of complaints, which joints are involved, presence of additional complaints, physical examination findings, additional symptoms, family history, trauma, and consumption of dairy products from raw milk, as well as some laboratory parameters and imaging modalities may serve as a guide in differential diagnosis. In children, arthralgias mostly have an acute onset and are associated with infections. In our study, the most common diagnosis in patients presenting with joint pain was brucella. This high rate of brucellosis is related to high rate of consumption of raw dairy products and stockbreeding in Konya and surroundings. Joint pain is included in differential diagnosis of many diseases due to nonspecific presenting complaints including fever, loss of appetite and malaise. Brucellosis should be considered in differential diagnosis and consumption of pasteurized dairy products should be encouraged in our country and the places where brucella is still prevalent like our region.
Açıklama
Anahtar Kelimeler
Eklem ağrısı, Artrit, Bruselloz, Artralji, Çocuk, Joint Paint, Arthritis,, Brucellosis, Arthralgia, Child
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yılmaz, H. S. (2022). Eklem Ağrısı İle Başvuran Çocukların retrospektif Değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
