When should I consider referring a child with suspected JIA to a specialist for further evaluation?

Consider referring a child with suspected juvenile idiopathic arthritis (JIA) to a specialist for further evaluation if:

• There is redness, swelling, or stiffness of the joint or limb, which may indicate inflammatory joint disease.
• The child has limp and stiffness that is worse in the morning, suggestive of inflammatory joint disease.
• The child is unable to bear weight or has painful limitation of range of motion.
• There is uncertainty about the cause of the limp or the cause cannot be managed in primary care.
• The child presents with a limp on multiple different occasions.

These features warrant urgent or specialist assessment to exclude juvenile idiopathic arthritis and other serious pathology.

Do not delay referral even if blood tests are normal or pending, as early specialist assessment is crucial for diagnosis and management.

Referral should be made to paediatric rheumatology or an appropriate specialist as soon as these signs are identified.

In addition, if the child has systemic features such as fever, unexplained rash, or other red flags, urgent specialist assessment is indicated.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be offered at the lowest effective dose while awaiting specialist review, but glucocorticoids should not be prescribed in primary care before specialist assessment.

This approach aligns with recommendations for early referral of children with suspected inflammatory arthritis to ensure timely diagnosis and treatment.

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