A 16-year-old girl has a 6-year history of intermittent knee pain. She presented previously at the age of 10 also for knee pain, which was attributed to growing pains. Now she describes pain in the knees worse at the end of the day and especially bad after exercise. Her knees are often sore after sitting and difficult pain on ascending stairs has adversely affected school attendance. Knee swelling occurs sometimes.
She also has pain in her hands, elbows and tops of her legs. Her joints often click so loudly that others can also notice. She seems well in other respects and, apart from the previous assessment for knee pain, there is no past medical history. Her general practitioner detected no obvious joint problem and the full blood count (FBC), erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) were reported as normal. Her GP noticed she has an unusual ability to bend the…
