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Swollen knee without history of trauma

My daughter is 13 and two weeks ago her knee became acutely swollen. There was no history of trauma. She just noticed it one evening when she said her knee felt "tight". The swelling is significant and the knee feels warmer than the other knee. She has mild pain on extension and when bending it tightly, but is walking around on it with hardly a limp. We have a friend who is an orthopedic surgeon who looked at it and said there are no mechanical abnormalities or evidence of a ligament injury. We have been icing it and wrapping it to try and reduce the swelling, but two weeks later it is basically the same. He doesn't feel imaging is necessary as we are unlikely to see any abnormalities given her otherwise normal ortho exam. Has anyone else been through this? I am starting to worry that if this isn't an ortho problem, that we need to consider something else like juvenile arthritis or other soft tissue problem in her knee. Maybe I should take her to the pediatrician instead?? My daughter is very athletic and swims on the swim team 6 days a week. She has a history of competitive gymnastics, but hasn't done gymnastics in over 2 years. Thanks for any feedback or advice!
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replied November 3rd, 2014
Thank you for asking

Dwelling of the knee without any trauma is likely a rheumatological origin. COuld be infection, could be some rheumatological manifestation. Needs evaluation, work up , imaging and a complete clinical correlation in light of a thorough exam.

Just get to a paediatrician and let them look in to this matter. No stress activity like swimming, skiing, running etc. keep the leg elevated and apply ice packs over the swelling.

Take care

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replied November 5th, 2014
Thank you so much for your reply. We had an xray taken yesterday and are going for an MRI tomorrow. I'm hoping this will point us in the right direction. She is very disappointed to not be able to be active!!
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replied January 30th, 2015
I just wanted to post an update to this in case anybody ever finds this information useful. I know I've spent hours trying to find anyone who has experienced this!!

X-ray and MRI of her knee showed effusion (swelling) but no major structural changes. She has slight roughening of the underside of her patella, but nothing significant enough to account for the degree of swelling she has. We saw our pediatrician next who ordered CBC, chemistry panel, ANA, lyme titer, sed rate, parvo virus titer, strep and rheumatoid factor. She was negative on all tests and her basic blood values were normal. We then saw a pediatric orthopedist as our pediatrician thought that the patella changes might signify some sort of patella instability that would account for her symptoms. The pediatric ortho took one look at her knee and said it was absolutely not an orthopedic problem and to get her to a pediatric rheumatologist. We finally got in to see one after a 4 week wait and she told us that she found swelling in both her knees. No other joints affected. She said it was arthritis secondary to a viral infection or to immune-mediated process. We did a trial of naproxen for a month to see if the swelling would subside. We saw no improvement at all. We just went back about 3 weeks ago for a recheck and her right knee is now just as swollen as her left. She said this is most likely juvenile idiopathic arthritis given her lack of response to the NSAIDs and how long it has been going on. We have an MRI with contrast scheduled for 2 weeks from now to look at the synovium and then she wants to treat her with steroid injection into the joints if the new medication we are on doesn't resolve the swelling.

Well, that's all the details I can think to share. Hope this is helpful for anyone else out there who is dealing with something similar. It's been a long road and a lot of doctors but apparently this isn't something that can be quickly or easily diagnosed.
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