To diagnose rheumatic diseases in children, the following steps are needed:

• Examining anamnesis/ medical history
• Physical examination
• Laboratory and Non-Laboratory Examination.

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Laboratory examination

On laboratory examination, if the following results are found, there are indications towards rheumatic disease:Increased ESR, C-reactive protein (CRP) or plasma viscosity.

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• Normocytic normochromic anemia, reactive thrombocytosis and mild elevations of alkaline phosphatase and gamma-GT are common in the acute setting.

• Perform examination of renal function and electrolytes to serve as baseline values before initiation of therapy as well as examination of uric acid/synovial fluid to rule out the possibility of polyarticular gout.

• On microscopic examination of urine can show the presence of connective tissue disease.

• Rheumatoid factor with positive results in 70-80% of patients.

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Non-Laboratory Examination

On non-laboratory examination, if the following results are found, rheumatic symptoms may be indicated;

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• X-Ray (X-ray of the associated joint): osteopenia and/or periarticular erosions are found.

• Ultrasound and MRI have high sensitivity in detecting synovitis, erosion and signs of inflammation that may not be detected by X-Ray.

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Author: dr. Fatimah Bebi (PRAMITA Clinical Laboratory Medical Consultant Doctor Jl. Diponegoro No. 37, Medan)