Differenzialdiagnostik nicht-entzündlicher Gelenkschmerzen/-schwellungen bei Kindern und Jugendlichen

Zusammenfassung

Muskuloskelettale Symptome der Gelenke sind ein häufiger Grund für Vorstellungen beim Kinderarzt, für die betroffenen Kinder jedoch nicht selten schwer zu beschreiben. Der untersuchende Arzt muss dann erkennen, ob die Gelenkschmerzen durch eine entzündliche oder nicht-entzündliche Erkrankung verursacht werden. Eine sorgfältige Anamnese kann wertvolle Hinweise auf die zugrundeliegende Ursache geben, die durch die körperliche Untersuchung weiter eingeengt werden kann. Insbesondere das Alter, das Schmerzmuster mit Tagesrhythmik und die Begleitsymptome sowie der Allgemeinzustand des Kindes helfen dem geübten Untersucher rasch weiter. Auch wenn das Spektrum der nicht-entzündlichen Gelenkerkrankungen weit und die Liste v. a. seltener Differenzialdiagnosen lang ist, lohnt es sich, einen Überblick über die häufigsten Ursachen zu behalten, um rasch zielgerichtete Untersuchungen zu veranlassen und überflüssige Diagnostik zu vermeiden. Wichtige Bereiche, die in die differenzialdiagnostischen Überlegungen einbezogen werden, sind v. a. maligne Erkrankungen, orthopädische Erkrankungen und chronische Schmerzstörungen. Aber auch alimentäre und andere Erkrankungen können im Kindesalter zu Gelenk- und Muskelschmerzen führen.

Abstract

Musculoskeletal joint symptoms are a common cause of visits to the paediatrician’s office, but children often find it hard to describe them. The examining practitioner then has to discern if the joint pain is due to an inflammatory or non-inflammatory condition. A careful history can give valuable hints as to the underlying cause, which can be further narrowed down through a physical examination. Age, temporal patterns of pain, concomitant symptoms and the patient’s general condition may be a quick aid to experienced doctors. Even though the spectrum of non-inflammatory joint conditions is wide and there is a long list of mostly rare differential diagnoses, it is worthwhile to maintain an overview of the most frequent causes to quickly arrange targeted investigations and avoid unnecessary tests. The most important conditions to be considered in the differential diagnosis are malignant diseases, orthopaedic conditions and chronic pain syndromes. However, nutritional and other disorders may also lead to joint and muscle pain in childhood.

Schlüsselwörter

Differenzialdiagnose - muskuloskelettale Schmerzen - nichtentzündlich - Kinder

Key words

Differential diagnosis - musculoskeletal pain - non-inflammatory - children

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