Reflex sympathetic dystrophy

Secondly, can the outcome of chronic anterior uveitis be predicted from the subtype of juvenile chronic arthritis with which it is associated?In other words, is there any sense in screening the subtypes at different frequencies?There is no doubt that the risk of developing chronic anterior uveitis varies with the subtype of juvenile chronic arthritis.Children with systemic onset juvenile chronic arthritis, rheumatoid factor positive polyarthritis, or spondyloarthritis are unlikely to develop chronic anterior uveitis, and as such probably do not warrant screening.However, there is little evidence to suggest that the outcome of the uveitis is related to the subtype of the arthritis.The risk of chronic anterior uveitis should determine who is enrolled in a screening programme, but the frequency of screening should be independent of the risk of chronic anterior uveitis and be based instead on the natural history ofthe disease.3M Rawes's assertion that joint aspiration for septic arthritis is associated with a poorer outcome because it results in late referral to orthopaedic surgeons is debatable.'An urgent diagnostic arthrocentesis may not only decompress the joint space but may also allow the initial choice of broad spectrum antibiotics to be modified appropriately in the light of microbiological evidence.4Rawes also implies that arthrotomy and joint washout is the treatment of choice for all forms of septic arthritis in children.There is evidence that some forms of septic arthritis may be successfully treated with a single aspiration of the affected joint and appropriate antibiotic cover, raising the possibility that arthrotomy may be sometimes an unnecessarily invasive surgical procedure.'For further informed debate on this important subject, Wilson and Di Paola's call for a multicentre, controlled, prospective clinical trial of treatment in childhood septic arthritis must be answered.6