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Investigations and Management

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 in the clinical context.
  • The approach to investigations must always focus on making an accurate diagnosis, planning management or monitoring of the disease. 
  • 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 helpful in the interpretation of tests. 
  • Imaging is useful but may need sedation in young children. It is important to plan investigations to gain the most information and minimise radiation exposure or need for sedation.
  • Radiographs or Computerised Tomography (CT) result in radiation exposure. 
  • Ultrasound scanning is increasingly used, does not result in radiation exposure and does not require sedation.
  • Magnetic Resonance Imaging (MRI) may need sedation.
  • Children may need analgesia to enable the clinical assessment to take place and during investigations. 

Approach to management 

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