II. Symptoms: Red Flags Suggestive of serious condition

  1. Fever
  2. Malaise
  3. Rest pain better with activity
  4. Morning Joint Stiffness or pain
  5. Night pain refractory to Tylenol or Ibuprofen

III. Signs: Red Flags Suggestive of serious condition

  1. Joint Swelling
  2. Bone tenderness to palpation
  3. Muscle Weakness
  4. Fall in height or weight growth curve

IV. Labs

  1. Complete Blood Count (CBC) abnormal
    1. Infection: Leukocytosis
    2. Malignancy
      1. Pancytopenia
      2. Thrombocytopenia with high sedimentation rate
  2. Increased acute phase reactants
    1. Erythrocyte Sedimentation Rate (ESR)
    2. C-Reactive Protein (CRP)
  3. Other labs to consider
    1. Antinuclear Antibody (ANA)

V. Imaging: XRay

  1. Soft tissue swelling
  2. Bone changes
    1. Osteopenia or bony cortex destruction
    2. Periosteal elevation
    3. Soft-tissue swelling

VII. Referral Indications (Suspected Rheumatic Condition)

  1. Persistent functional loss
    1. Unable to attend school, activities due to condition
    2. Motor skill regression
  2. Discrepant symptoms, signs and labs
    1. Persistent localized pain, swelling with normal labs
    2. Abnormal exam findings with normal labs
    3. Abnormal labs do not match symptoms and signs
  3. Unexplained persistent symptoms and signs
    1. Musculoskeletal pain or swelling
    2. Weakness or Fatigue
    3. Anorexia and weight loss
    4. Anemia
    5. Fever
    6. Rash

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