Q: What would cause a 14-year-old girl to have joint pain? Her knee and wrist swell and cause her a great deal of pain. The wrist had a bluish color for a while. It went away, but the swelling and pain did not. She had an MRI done, but it showed nothing.
A: Among the many potential causes of joint pain and swelling in a 14-year-old girl, here are some of the most common:
- Juvenile rheumatoid arthritis (also called juvenile idiopathic arthritis)
- Arthritis associated with psoriasis (psoriatic arthritis) or colitis (such as Crohn's disease or ulcerative colitis)
- Lupus (also called systemic lupus erythematosus, or SLE)
- Infection, including viral infections, bacterial infections, and Lyme Disease
- Blood diseases, including hemophilia
The blue discoloration in the wrist that resolved raises the possibility of trauma, which may or may not be related to her other joint pains.
Additional information would be helpful in sorting out the cause. For example, her doctors will want to know:
- How long symptoms have been present
- Whether she had an injury prior to the joint pain
- If she's had tick bites (or exposure to ticks), psoriasis, or diarrhea or other gastrointestinal symptoms
- Whether she's had past developmental or congenital problems in the joints
- If she's had fever, rash, or eye problems
- If there is any family history of joint problems
Although an MRI can demonstrate the internal structures of the joints in remarkable detail, it may not help in sorting out the cause of joint pain and swelling. It often tells us what we already know: that there is inflammation and swelling in the joint. In fact, an MRI is often most helpful at what it does not show. For example, her MRI presumably did not show evidence of bone infection (which can complicate a joint infection).
The only way to sort out the cause of an adolescent's joint pain and swelling is for her doctors to review her medical history in detail and perform a thorough physical examination. Based on the most likely conditions, one or more tests may be helpful. These might include blood tests, additional imaging tests, or analysis of the joint fluid. Occasionally, a biopsy of the joint lining may be recommended. Tuberculosis, for example, may be diagnosed in this way. Referral to a specialist, such as a rheumatologist or orthopedist, may be appropriate if her pediatrician cannot establish a diagnosis.
It's not rare that the specific cause of persistent arthritis in a child remains uncertain even after full evaluation with specialists. The diagnosis in such cases is usually juvenile idiopathic arthritis, a chronic condition of unknown cause. Fortunately, there are many effective therapies.
More on MSN Health & Fitness:
- Top 10 Things That Don't Cause Arthritis
- Can Foods Trigger Arthritis Pain?
- Arthritis Pain: Do's and Don'ts
Do you have a health question you'd like to ask Harvard Medical School's experts? Send an e-mail to firstname.lastname@example.org. Please include Ask Harvard in the subject line.
Our experts respond to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.
be well, feel better
These asanas can help you prevent injury and recover more quickly.
How to tell whether a pool, beach or lake is safe for swimming and (adequately) germ-free.
Celebrities are candidly sharing their stories of heartbreak and loss (sadly, up to 25 percent of pregnancies end in miscarriage) to hopefully help other women feel like they’re not alone. Here are the famous faces who’ve had the courage to say they’ve experienced miscarriage.
Teenagers aren't the only ones who break out. Discover the truth about treating adult acne and get clear skin for good.
From the impractical to the downright dangerous, these diets aren't your best choice for losing weight.
Tasty in-season eats that will make you AND your swimsuit happy.
You won't find any CGI behind these celebrity six-packs.
We don't know about you, but we prefer to do a little prep work before going full Monty—or even mostly Monty. And we don't mean three months of squats. These tricks from nutritionists, trainers and dermatologists aren't going to replace long-term exercise, but they will make a noticeable difference, if only in the short term. Plus, they're a little more fun than squats.