DOWN'S SYNDROME : INFLAMMATORY ARTHROPATHY. Key Points.

(based on a presentation by Dr Janet Gardner-Medwin. DSMIG Glasgow. May 2007)

Probably about three times as common as juvenile idiopathic arthritis in other children.
Should be suspected in all children with Down’s syndrome who present with difficulty walking or where other functional deterioration is reported.
Difficult to diagnose and frequently overlooked because:
- children with Down’s syndrome tend not to express pain
- confusion due to syndrome-associated joint hypermobility.
- formal musculoskeletal examination rarely carried out.
- X Ray changes are late
- ANA positive in only 40%
Functional adaptations occur
Key clinical sign:
- stiffness (gelling) - early morning or after immobility. Improves on mobilizing
Formal musculoskeletal examination essential
Ultrasound or MRI can identify synovitis, but a competent rheumatologist will be able to make a clinical diagnosis in most cases.
Response to treatment is not good, but in some children does significantly improve outcome. Early treatment more efficacious than late.
Children with Down’s syndrome should have a 5 minute musculoskeletal assessment every year. See pGALS – A musculoskeletal screening assessment (Word doc) from the Arthritis Research Campaign
JIA associated with chronic anterior uveitis, and unclear if Down’s risk is different therefore slit lamp examination recommended for those with active disease

JGM/JD November 2007