American Academy of Pediatrics – Section on Rheumatology
View all recommendations from this societyAugust 6, 2019
Do not send periodic fever syndrome genetic panels prior to infectious and oncologic work up or in a patient without clear evidence of recurrent fever.
Fever is a common complaint in the pediatric age group with infectious etiology as the most common followed by malignancy. Thorough history and physical exam in addition to diligent documentation of fever and accompanying symptoms can often help define underlying etiology, minimizing as well as targeting additional work-up. Of note, most children with a periodic fever syndrome do not have a genetic mutation, and the most common periodic fever syndrome – PFAPA (periodic fever, adenitis, pharyngitis, aphthous ulcer) – is not associated with a monogenic mutation.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Academy of Pediatrics’ Section on Rheumatology (SORh) consists of pediatric rheumatologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of rheumatologic disease in children and adolescents. The SORh strives to inform pediatricians, parents, communities, and policy makers on rheumatic disease in children. The fellow members of the SORh were queried to develop a list of diagnostic and management decisions that have resulted in misuse of laboratory studies and resources. Through a series of votes, the fellow members developed the list into five statements to address the most common misconceptions seen when encountering pediatric autoimmune conditions. The fellows involved in this project are: Kathleen Collins, Brian Dizon, Suhas Ganguli, Miriah Gillispie, Marla Guzman, Michael B. Nelson, Onengiya Harry, Meiqian Ma, MaiLan Nguyen, Amir Orandi, Amanda Schlefman, Laura Tasan, and Erin Treemarcki. The list was shared with membership of the SORh Executive Committee for feedback and then finalized by collaboration. These five clinical issues are the result. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
Antoon J, Peritz D, Parsons M, Skinner A, Lohr J. Etiology and resource use of fever of unknown origin in hospitalized children. Hosp Pediatr. 2018;8(3):135-140.
Antoon J, Potisek N, Lohr J. Pediatric fever of unknown origin. Pediatr Rev. 2015;36(9):380-390.
Chusid M. Fever of unknown origin in childhood. Pediatr Clin North Am. 2017;64(1):205-230.
Gattorno M, Sormani M, D’Osualdo A, et al. A diagnostic score for molecular analysis of hereditary autoinflammatory syndromes with periodic fever in children. Arthritis Rheum. 2008;58(6):1823-1832.
Tchernitchko D, Moutereau S, Legendre M, et al. Mefv analysis is of particularly weak diagnostic value for recurrent fevers in western European Caucasian patients. Arthritis Rheum. 2005;52(11):3603-3605
