II. Symptoms: Red Flags Suggestive of serious condition
- Fever
- Malaise
- Rest pain better with activity
- Morning Joint Stiffness or pain
- Night pain refractory to Tylenol or Ibuprofen
III. Signs: Red Flags Suggestive of serious condition
- Joint Swelling
- Bone tenderness to palpation
- Muscle Weakness
- Fall in height or weight growth curve
IV. Labs
-
Complete Blood Count (CBC) abnormal
- Infection: Leukocytosis
- Malignancy
- Pancytopenia
- Thrombocytopenia with high sedimentation rate
- Increased acute phase reactants
- Erythrocyte Sedimentation Rate (ESR)
- C-Reactive Protein (CRP)
- Other labs to consider
- Antinuclear Antibody (ANA)
V. Imaging: XRay
- Soft tissue swelling
- Bone changes
- Osteopenia or bony cortex destruction
- Periosteal elevation
- Soft-tissue swelling
VI. Causes: Serious Conditions with Musculoskeletal Pain
VII. Referral Indications (Suspected Rheumatic Condition)
- Persistent functional loss
- Unable to attend school, activities due to condition
- Motor skill regression
- Discrepant symptoms, signs and labs
- Persistent localized pain, swelling with normal labs
- Abnormal exam findings with normal labs
- Abnormal labs do not match symptoms and signs
- Unexplained persistent symptoms and signs