Background Musculoskeletal complaints are common in children in the developed countries. (1) However, most of these are non-inflammatory, and prevalence of juvenile idiopathic arthritis is 7-220 per 100,000. (2) There is limited data from developing countries, including India. Thus, we studied these in Indian school going children.
Objectives Look at prevalence of musculoskeletal complaints and juvenile idiopathic arthritis in Indian school-children. Also to look for hypermobility and association with musculoskeletal complaints.
Methods This cross-sectional study was conducted from June 2010-March 2011 among school children aged 6-17 years. Initially, a questionnaire on musculoskeletal complaints was distributed. These had to be filled up by parents in children younger than 14 years of age, but older children could fill it themselves. Subsequently, all children were individually met and their answers verified. Also, a 2nd year rheumatology fellow did an abbreviated musculoskeletal examination (GALS) (3) and checked for hypermobility (Beighton’s scoring).
Results A total of 2059 children (851 girls:1208 boys) were included in the study. Their mean age was 11.5±2.9 yrs. After verification by direct questioning, joint pain (more than 1 week) was present in 158 (7.6%), back pain was present in 63 (3.1%) and heel pain in 62 (3%) children. On examination, 1064 children (51.7%) had hypermobility (Beighton score ≥4), with no gender predilection. Of these, 483 (45.4%) were symptomatic, most with transient joint pains (less than 1 week), a higher prevalence than in those without hypermobility (p<0.001). However none had hypermobility syndrome. None of the children had any evidence of arthritis. Two children had inflammatory back pain, one of whom was confirmed to have enthesitis related arthritis (JIA-ERA) (enthesitis, X-ray showing sacroilitis and HLA-B27 positive).
Conclusions Musculoskeletal complaints especially joint pain was not uncommon in Indian children. Hypermobility was common, being present in half of the children; also hypermobile children had more musculoskeletal complaints. The estimated prevalence of JIA was 48/100,000 in Indian children.
Ziv A, Boulet JR, Slap GB. Utilization of physician offices by adolescents in the United States. Pediatrics. 1999;104:35-42.
Manners PJ, Diepeveen DA. Prevalence of juvenile chronic arthritis in a population of 12-year-old children in urban Australia. Pediatrics 1996;98:84-90.
Foster HE, Kay LJ, Friswell M, Coady D, Myers A. Musculoskeletal screening examination (pGALS) for school-age children based on the adult GALS screen. Arthritis Rheum. 2006 15;55:709-16.
Disclosure of Interest None Declared