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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:

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. 

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