Figure 60.1 depicts an algorithm for the diagnostic approach to the child with joint pain The evaluation should include inquiries about the specific joint(s) involved, symptom duration, and history of trauma, fever, rash, tick bites, sexual risk factors, intravenous drug use, and recent illnesses The child’s past medical and family histories should be reviewed A family history of systemic lupus erythematosus (SLE), inflammatory bowel disease, or rheumatoid arthritis increases the child’s risk for autoimmune-related diseases A comprehensive physical examination should be performed with particular attention paid to a search for rashes, heart murmurs, and abdominal abnormalities Assessment of the affected joint(s) should determine if it is warm, swollen, or tender as well as its range of motion