Tonsilltis followed by joint pains?

Patient : My daughter is 7.5 year old and been suffering from Tonsillitis from last 2 years. Lately (last 2 months), she has been compaining of joint pain (knee, ankle, elbow). No inflammatiom, no fever and no swelling can be seen in those areas. Her ASO titre is less than 50 and Ecocardiography is completely normal. Is she suffering from Rheumati fever ?. If not. what could be the possible reason for her joint pain.
Doctor :   Rheumatic fever will present as an acute problem with high fever and increased ASO titres. What your daughter may be hav ing is Juvenile rheumatoid arthritis which is causing the joint pain in the major joints. She needs to get her ESR and Rheumatoid Factor checked along with xrays of the joint. Please consult a pediatirc orthopedic doctor for further follow up. All the best.

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