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INTRODUCTION

I would go to the doctor and start crying. I couldn’t help it. I just want a chance to play on the same field as other people, I want to feel normal, but as frightening as the diagnosis was, it was also a relief.

Venus Williams, seven-time Grand Slam winner, on being diagnosed with Sjögren’s syndrome

Musculoskeletal complaints are common in individuals engaging in physical activity. However, not every clinical condition that presents to the sports clinic is due to a mechanical sports-related diagnosis. Athletes may have other systemic pathologies of a prolonged inflammatory nature that present as a mechanical injury. These chronic progressive inflammatory diseases may lead to joint pathology and even joint destruction in the most severe cases.

The clinician must be able to differentiate between a sports injury and possible rheumatological disease.13 Prompt and effective treatment can modify disease progression, allowing the athlete to continue with their regular exercise program. Despite being diagnosed with Sjögren’s syndrome in 2011, Venus Williams was able to maintain her elite level of competition with effective therapy, returning to a world top-five ranking and reaching further tennis Grand Slam finals in 2017.

Early intervention is even more important in the general population, where reduced medical support could result in greater risk of joint damage and disability. As always, a thorough history and clinical examination are essential.

The clinical key to diagnosing a rheumatological condition is to recognise the patient’s clinical features that do not fit the typical pattern of a common sports-related condition and come to a differential diagnosis. Special investigations including relevant blood tests and imaging will help confirm the diagnosis.

In this chapter we discuss the clinical approach to diagnosing a patient with a musculoskeletal complaint that is not an acute sports injury. The focus is on rheumatological conditions.1, 4

AGE

Arthritis is often considered a condition of old age. This, however, does not hold true, as children are also affected. In fact, juvenile arthritis is well recognised and is an umbrella term used to describe all the inflammatory and autoimmune diseases that can develop in children younger than 16 years old.2, 5

Juvenile arthritis can manifest in many ways. One or many joints can be involved, and a complete history and physical examination should cover symptoms and signs like fever, skin rash and eye problems. Uveitis is an important complication affecting approximately one in every three individuals with autoimmune disease.6

There are five types of juvenile arthritis:7, 8

  • systemic arthritis (Fig. 15.1a)

  • oligoarthritis (pauci-articular disease) (Fig. 15.1b)

  • polyarthritis (Fig. 15.1c, d)

  • psoriatic arthritis

  • enthesitis-related arthritis.

Figure 15.1

Various manifestations of juvenile idiopathic arthritis (JIA) (a) Systemic arthritis—Example of growth retardation in ...

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