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A7.5 Limb Pain and swelling in children: sometimes it's not inflammation!
  1. Susana Fernandes,
  2. José António Melo Gomes
  1. Instituto Português de Reumatologia, Lisbon, Portugal

Abstract

Background and Objectives Algodystrophy or Reflex Sympathetic Dystrophy is a localised chronic pain syndrome characterised by extreme and persistent pain, functional disability and refusal of mobilisation of a specific segment. Algodystrophy in children has several specific characteristics that are distinct from the disease seen in adults. Psychological stress and other psychological comorbidities play a prominent role in children, with frequent reports of a previous history of familiar problems, bullying or sexual abuse. Significant preceding trauma is not a common event in most paediatric series, as well as previous severe disease. This condition is more common in adolescent girls and pain typically occurs in a single lower extremity. Radiographs of the affected extremity are usually normal in paediatric patients and technetium bone scintigraphy usually show decrease uptake. Pharmacologic agents have a limited role in the treatment of these children. A multidisciplinary approach should be performed, including psychological, behavioural and occupational therapy. The authors present three case reports of Algodystrophy in children.

Material and Methods Three patients from a Portuguese Pediatric Rheumatology centre.

Results The first case is a ten year old girl presenting with severe arthralgia, diffuse edema and refusal to use the left foot which was experience a history of bulling in school. The second report of an eight year old girl, with a previous injury reported, presenting with arthralgia, allodynia and refusal to use the right foot, also with a previous history of bullying. And a third case of sixteen year old girl with severe pain, edema, cyanosis and functional impairment of her right hand that progress to addition of her left leg in which a history of previous sexual abuse has been found. One of these patients has been previous and wrongly treated with anti-TNF agents, without any clinical result.

Conclusions The diagnosis of Algodystrophy in children must lead to a careful investigation of an underlying psychological cause. Its correction is the only way that allows a correct approach of these children and adolescents and enables to provide the best medical care.

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