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Approach to investigation

  • In paediatric rheumatology, bedside (clinical) evaluation is key to making a diagnosis.  Laboratory tests are used to support the process and may confirm or exclude diagnostic possibilities.  'Positive tests' may be misleading and must be interpreted within the clinical context.
  • The approach to investigations must always focus on making an accurate diagnosis, planning management, or monitoring disease activity or side effects of treatment.
  • Taking blood from children can be traumatic so it is important to make sure that venepuncture is done by experienced staff. Tests must always be justified and the minimum amount of blood taken. Knowing normal values is essential in the interpretation of tests.
  • Imaging is useful but sedation may be needed in young children. It is important to consider which investigations will provide the most information, to minimize radiation exposure and the need for sedation.
  • Plain Radiographs and Computerized Tomography (CT) scans result in radiation exposure.
  • Magnetic Resonance Imaging (MRI) does not result in radiation, but may require sedation.
  • Ultrasound scanning is increasingly used, does not result in radiation exposure and does not require sedation.
  • Children may need analgesia to enable the clinical assessment to take place and during investigations. 

Approach to management 

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