{ "schema_version": 1, "kind": "condition", "id": "transient-synovitis-hip", "name": "Transient synovitis of the hip (irritable hip)", "category": "acute", "sources": "Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/ · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-full.txt) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)", "review_status": "reviewed", "verified_against": "Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/ · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-full.txt) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1805, "generic": "Ibuprofen", "line": 1, "is_adjunct": false, "form": "oral.liquid", "strength_mg": 100.0, "adult_dose": "200 to 400 mg 3 to 4 times daily (max. 1200 mg daily) for a patient 12 years and over", "adult_duration": "According to clinical response; symptoms generally improve after 24 to 48 hours", "dose_source": "MSF Essential Drugs 2024 (ibuprofen oral monograph)", "rationale": "Indication claim, disease article: once a full diagnostic work-up has established transient synovitis, the management is supportive care and rest from activity, with a non-steroidal anti-inflammatory available for the pain. The article names the class and not a molecule. Dose claim, MSF Essential Drugs 2024 ibuprofen oral monograph, under indications covering mild to moderate pain, fever and rheumatic disease: a child over 3 months takes 5 to 10 mg/kg, given 3 or 4 times a day, to a ceiling of 30 mg/kg daily. Ibuprofen is the NSAID the Egyptian register actually stocks as a paediatric suspension - 21 oral-liquid products under that spelling.", "cautions": [ "PAIN RELIEF IS NOT A DIAGNOSTIC TEST. A child whose hip settles on ibuprofen may still have septic arthritis - see the referral and safety-netting advice before treating and sending home.", "MSF contraindicates it in: a child under 3 months of age; allergy to any NSAID; peptic ulcer; a clotting defect, active bleeding, or surgery that risks heavy blood loss; severe kidney or liver impairment; severe heart failure; severe malnutrition; dehydration or hypovolaemia that has not been put right; and severe infection. A febrile, dehydrated or septic-looking child is the wrong child for an NSAID.", "MSF lists as possible harms: allergic reactions, pain in the upper abdomen, peptic ulcer, bleeding, and impaired kidney function. It says to give the drug carefully to the elderly and to asthmatics.", "MSF says: do not combine it with methotrexate, with anticoagulants, or with another NSAID; and to monitor the combination with a diuretic or an ACE inhibitor - the patient should drink plenty, to keep the kidneys out of trouble.", "MSF on how to give it: with food, and with at least 4 hours between doses.", "The disease article's other measures cost nothing - heat applied to the hip, or massage.", "STOP AND RETHINK ON A TIMER - if the symptoms are still significant 7 to 10 days after the child first presented, think of another diagnosis. Do not keep repeating the syrup." ], "peds_mgkg_low": 5.0, "peds_mgkg_high": 10.0, "peds_max_mg": null, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Over 3 months of age: 5 to 10 mg/kg, given 3 or 4 times a day, with 30 mg/kg in a day as the usual ceiling. MSF's own absolute ceiling is higher: up to 40 mg/kg daily in a child. The suspension is 100 mg per 5 ml, and the MSF pipette is marked off by body weight - one kilogram graduation delivers 10 mg of ibuprofen.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 3.0, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 50, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 100, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 150, "high_mg": 300, "capped": false }, { "weight_kg": 40, "low_mg": 200, "high_mg": 400, "capped": false } ], "brands": [ { "trade_name": "NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUPROFEN 100MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MARCOFEN 100MG/5ML SUSP. 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 5.85, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAFO 100MG/5ML SYRUP 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBUCALMIN 100MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 28.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "JUSPOLED 100MG/5ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > JASPER FOR PHARMACEUTICAL INDUSTRIES", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEGAFEN-N 100MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 35.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEN 100MG/5ML SYRUP 150ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 44.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BRUFEMOL-N SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "IBUFEN 2% SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "transient-synovitis-hip" }, { "id": 1806, "generic": "Rest and supportive care (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)", "rationale": "Rest is named ahead of any drug in the article's management sentence, and the expected course is what turns a frightening limp into a manageable week at home.", "cautions": [ "Treatment is supportive: rest from activity, and nothing more heroic. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "THE COURSE TO PROMISE THE FAMILY - things usually start to ease within 24 to 48 hours. In about 75% of children everything has gone within 1 to 2 weeks; the rest keep milder symptoms for some weeks more. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "RECURRENCE IS COMMON AND IS NOT A FAILURE - the article puts it at as many as 20% to 25% of children in one place and at 4% to 17% in another, with most second episodes arriving inside 6 months. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Warn the parents so the second episode does not arrive as a crisis.", "The main complication is simply that it comes back. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "Symptoms lasting past a month are a different disease - where they have run beyond 1 month, the article reports that a different pathology was found. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)" ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "transient-synovitis-hip" }, { "id": 1807, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)", "rationale": "Transient synovitis is a diagnosis of exclusion, and everything it must be excluded from is worse than it is. Carries the Kocher criteria, the workup the article requires before the label is applied, and the serious differentials.", "cautions": [ "RED FLAG - SEPTIC ARTHRITIS. The Kocher criteria: a white cell count above 12,000 per microlitre of serum; the child will not or cannot bear weight; fever above 38.5 degrees C; and an ESR above 40 mm/hr. With all four present, the article puts the probability of septic arthritis at 99.6%.", "With none of those risk factors present at the visit, the article puts the chance of a septic hip below 0.2%. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Four negatives is the reassuring combination; three positives is an emergency.", "TEMPERATURE IS THE STRONGEST SINGLE SIGN - a temperature above 38.5 C predicted septic arthritis better than anything else, and after it, in the article's stated order: a CRP above 1 mg/dL, then the ESR, then refusal to bear weight, then the white cell count. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "THIS IS NOT A CLINIC-ONLY DIAGNOSIS - the work-up the article asks for is a white cell count, a CRP, an ESR, an x-ray of the hip and an ultrasound. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Without those, the label has not been earned.", "A CRP above 2 mg/dL is on its own a risk factor for septic arthritis. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "REFER FOR ASPIRATION WHERE THERE IS AN EFFUSION - ultrasound picks up fluid inside the joint capsule very reliably, and aspirating under ultrasound both relieves the pain and the stiffness and often separates this quickly from septic arthritis. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "IF IN DOUBT, ADMIT - where there is clinical concern, or the diagnosis will not settle, admitting the child allows repeated assessment after a first period of supportive treatment. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "THE OTHER DIAGNOSES TO EXCLUDE, in the article's list: osteomyelitis, septic arthritis, a primary or secondary bone lesion, Legg-Calve-Perthes disease, a slipped capital femoral epiphysis, and also Lyme arthritis, pyogenic sacroiliitis and juvenile rheumatoid arthritis. An overweight adolescent with hip or knee pain is a SCFE until x-rayed.", "Acute hip pain calls for those alternatives to be excluded first, above all the ones that leave lasting damage when they are not caught quickly. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)", "LATE CONSEQUENCE TO KNOW ABOUT - Legg-Calve-Perthes disease follows in 1% to 3% of them. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) A child with a second or third episode deserves an orthopaedic opinion, not another course of syrup." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "transient-synovitis-hip" } ] }