Definição e caraterização de dor musculoesquelética e doenças associadas
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v28.i4.15457Palavras-chave:
aguda, artralgia, artrite, crónica, definições, dor musculoesquelética, poliartrite, semiologia, subagudaResumo
A dor musculoesquelética é um motivo frequente de procura de cuidados de saúde em qualquer idade, incluindo a pediátrica. O rigor semiológico, com uma anamnese cuidada e um exame objetivo sistemático e pormenorizado, é obrigatório. Somente a utilização de uma linguagem rigorosa e padronizada permitirá a comunicação correta, evitando incorrer em ambiguidades de definição e interpretação e em consequentes omissões ou sobrevalorização de manifestações clínicas, culminando em erros de diagnóstico.
O presente artigo compila e define os múltiplos conceitos de dor musculoesquelética, com o objetivo de uniformizar e clarificar a linguagem médica. Considerando conceitos gerais, a evolução temporal e a localização da dor musculoesquelética, os autores reúnem 85 conceitos, maioritariamente de manifestações dolorosas, e descrevem-nos de forma sucinta e prática.
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Referências
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2. Burke MG. Extremity pain. In: Hoekelmann RA, Friedman SB, Nelson NM, Seidel H, Weitzman ML. Primary Pediatric Care, 3th ed. St. Louis, Mosby; 1997:940-5.
3. De Inocencio J, Carro MA, Flores M, Carpio C, Mesa S, Marín M. Epidemiology of musculoskeletal pain in a pediatric emergency department. Rheumatol Int 2016; 36:83-9.
4. Guimarães CV, Pedroso H, Conde M. Artralgia. In: Pedroso H, Martins S. Abordagem em consulta de pediatria, da criança ao adolescente. Lisbon, Bene Farmacêutica, 2015:96-9.
5. Sawyer SS. Examination of the musculoskeletal system. In: Sawyer SS. Pediatric Physical Examination & Health Assessment. Sudbury, Jones & Bartlett Learning; 2012:421-501.
6. Lehman TJA. In: Juvenile Arthritis. Lehman TJA. A Clinician’s Guide to Rheumatic Diseases in Children. New York, Oxford University Press; 2009:90-124.
7. Melo Gomes JA. A criança com Doença Reumática. In: Palminha JM, Carrilho EM. Orientação Diagnóstica em Pediatria. Dos sinais e sintomas ao diagnóstico diferencial. Lisbon, Lidel; 2003:849-90.
8. Rovenský J, Payer J. Dictionary of Rheumatology. Vienna, Springer; 2009.
9. Laxer RM, Wright J, Lindsley CB. Infectious Arthritis and Osteomyelitis. In: Petty R, Laxer R, Lindsley C, Wedderburn L. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Elsevier; 2016:533-50.
10. Petty R, Laxer R, Wedderburn L. Juvenile Idiopathic Arthritis. In: Petty R, Laxer R, Lindsley C, Wedderburn L. Textbook of Pediatric Rheumatology, 7th ed. Philadelphia, Elsevier; 2016:188-204.
11. Laxer RM, Sherry DD, Hashkes PJ. Juvenile Idiopathic Arthritis (JIA). In: Laxer RM, Sherry DD, Hashkes PJ. Pediatric Rheumatology in Clinical Practice. 2nd ed. Toronto, Springer; 2016:31-62.
12. Salgado M. As “Dores de crescimento” na criança. In: Pedroso H, Martins S. Abordagem em consulta de pediatria, da criança ao adolescente. Lisboa, Bene Farmacêutica; 2015:93-5.
13. Mohanta MP. Growing pains: Pratitioners’ dilemma. Indian Peditr 2014; 51:379-83.
14. Staheli LT. Fundamentals of Pediatric Orthopedics. 5th ed. Seatle, Wolters Kluwer; 2016.
15. Herring JA. Tachdjian’s Pediatric Orthopaedics. From the Texas Scottish Rite Hospital for Children. 5th ed. Philadelphia, Elsevier Saunders; 2014.
16. Seabra JF. Ortopedia Infantil - O Fundamental. Coimbra, ASIC; 2016.
17. Jacobs JC. Differential Diagnosis of Arthritis in Childhood. In: Jacobs JC. Pediatric Rheumatology for the Practitioner, 2nd ed. New York, Springer-Verlag; 1993:25-230.
18. Spencer CH, Patwardhan A. Pediatric rheumatology for the primary care clinicians-recognizing patterns of disease. Curr Probl Pediatr Adolesc Heath Care 2015; 45:185-206.
19. Foster H, Jandial S. Clinical Examination of the Child with a Rheumatic Disease. In: Sawhney S, Aggarwal A. Pediatric Rheumatology. A Clinical Viewpoint. Singapore, Springer; 2017:89-105.
20. Haines KA. The approach to the child with joint complaints. Ped Clin N Amer 2018; 65:623-38.
21. Weiss JE, Stinson JN. Pediatric pain syndromes and noninflammatory musculoskeletal pain. Ped Clin N Amer 2018; 65:801-26.
22. Davies K, Coperman A. The spectrum of paediatric and adolescent rheumatology. Best Pract Res Clin Rheumatol 2006; 20:179-200.
23. da Silva JA, Woolf AD. Rheumatology in Practice. London, Springer-Verlag; 2010.
24. Murias Loza S, Remesal Camba A, Alcobendas Rueda R. Artritis. In: Guerrero-Fenández J, Cartón Sánchez AJ, Borreda Bonis AC, Menéndez Suso JJ, Ruiz Domínguez JA. Manual de Diagnóstico y Terapéutica en Pediatria. Buenos Aires, Editorial Medica Panamericana; 2018:2081-9.
25. del Moral OM, Salvat IS, Ibarra JM, Cuenca JM. El síndrome de dolor miofascial y los puntos gatillo miofasciais. In: del Moral OM, Salvat IS. Fisioterapia Invasiva del Síndrome de Dolor Miofascial. Manual de punción seca de puntos gatillo. Buenos Aires, Editorial Médica Panamericana; 2017:3-25.
26. Angus-Leppan H, Guiloff RJ. Familial limb pain and migraine: 8-year follow-up of four generations. Cephalagia 2016; 36:1086-93.
27. Carapetis JR, Currie BJ. Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Arch Dis Child 2001; 85:223-7.
28. Mistry RM, Lennon D, Boyle MJ, et al. Septic arthritis arthritis and acute rheumatic fever in children. J Pediatr Orthop 2014; 35:318-22.
29. Ferguson PJ, Laxer RM. Autoinflammatory bone disorders. In: Petty R, Laxer R, Lindsley C, Wedderburn L. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Elsevier; 2016:627-41.
30. Weisman SJ. Multidisciplinary approaches to chronic pain. In: Walco GA, Goldschneider KR, Pain in Children. A Practical Guide for Primary Care. Totowa, Humana Press; 2008:133-43.
31. Schmidt RF, Gebhart GF. Encyclopedia of Pain, 2nd ed. Heidelberg, Springer; 2013.
32. Fernández-de-las-Peñas C, Arendt-Nielsen L. Myofascial pain and fibromyalgia: two different but overlapping disorders. Pain Manag 2016; 6:401–8.
33. Simpson DM, McArthur JC, Dworkin RH. Neuropathic Pain: Mechanisms, Diagnosis and Treatment. Oxford, Oxford University Press; 2012.
34. Prashanth GP, Bhandankar M, Patil VD. Migratory polyarthritis as a paraneoplastic syndrome in childhood leukemia. Rheumatol Int 2013; 33:1647-8.
35. Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the american heart association. Circulation 2015; 131:1806-18.
36. Sanmarti R, Salvador G. Palindromic rheumatism and other relapsing arthritis. Best Pract Res Clin Rheumatol 2004; 18:647-61.
37. Cabrera-Villalba S, Sanmarti R. Palindromic rheumatism: a reppraisal. Int J Clin Rheumatol 2013; 8:569-77.
38. Merskey H, Bogduk, N. Part III: Pain Terms: A Current List with Definitions and Notes on Usage. In: IASP Task Force on Taxonomy. Classification of Chronic Pain, Second Edition (Revised). Washington, International Association for the Study of Pain; 2012.
39. Rodrigues AC, Kang PB. Neuropathic and myopathic pain. Sem Pediatr Neurol 2016;23:242-7.
40. Terreri MTRA, Len CA, Hilário MO, Ishida A, Pinto JA, Kuwajima SS. Locomotor. In: Puccini RF, Hilário MO. Semiologia da Criança e do Adolescente. Rio de Janeiro, Guanabara Koogan, 2008:220-38.
41. Sherry DD, Bohnsack J, Salmonson K, Wallace CA, Mellins E. Painless juvenile rheumatoid arthritis. J Pediatr 1990; 116:921-3.
42. Foster HE, Eltringham MS, Kay LJ, Friswell M, Abinun M, Myers A. Delay in acess to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis. Arthr Rheum 2007; 57:921-7.
43. McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics 2002; 110:354-9.
44. Leet AI, Skaggs DL. Evaluation of the acutely limping child. Am Fam Physician 2000; 61:1011-8.
45. Naranje S, Kelly DM, Sawyer JR. A systematic approach to the evaluation of a limping child. Am Fam Physician 2015; 92:908-16.
46. Hills BA, Thomas K. Joint stiffness and “articular gelling”: inhibition of the fusion of articular surfaces by surfactant. Br J Rheumatol 1998; 37:532-8.
47. Leung AKC, Wong BE, Chang PY, Cho HY. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc 1999; 91:329-32.
48. Leung AKC, Wong BE. Leg cramps in children. Clin Pediatr (Phila) 1997; 36:69-73.
49. Matthews E, Silwal A, Sud R, Hanna MG, Manzur AY, Muntoni F, et al. Skeletal muscle channelopaties: rare disorders of common pediatric syymptoms. J Pediatr 2017; 188:181-5e6.
50. Quinlivan R, Jungbluth H. Myopathic causes of exercise intolerance with rhabdomyolysis. Dev Med Child Neurol 2012; 54:886-91.
51. Scott DL, Khoshaba B, Choy EH, Kingsley GH. Limited correlation between the health assessment questionnaire (HAQ) and EuroQol in rheumatoid arthritis: questionable validity of deriving quality adjusted life years from HAQ. Ann Rheum Dis 2007; 66:1534-7.
52. Mosek A. The Medical Evaluation of Pain. In: Kreitler S, Beltrutti D. The Handbook of Chronic Pain. New York, Nova Science Publishers; 2007:145-51.
53. Arendt-Nielsen L, Svensson P. Referred muscle pain: basic and clinical findings. Clin J Pain 2001; 17:11-9.
54. Madden S, Kelly L. Update on acute rheumatic fever: it still exists in remote communities. Can Fam Physician 2009; 55:475-8.
55. Butbul-Aviel Y, Uziel Y, Hezkelo N, Brik R, Amarilyo G. Is palindromic rheumatism amongst children a benign disease? Pediatr Rheumatol Online J 2018; 16:12.
56. Sreenivas T, Nataraj AR, Meno J, Patro DK. Acute multifocal haematogenous osteomyelitis in children. J Child Orthop 2011; 5:231-5.
57. Perlman MH, Patazakis MJ, Kumar PJ, Holtom P. The incidence of joint involvement with adjacent osteomyelitis in pediatric
patients. J Pediatr Orthop 2000; 20:40-3.
58. Bahk Y-W. Diseases of Joints and Soft-Tissue Infections. In: Bahk Y-W. Combined Scintigraphic and Radiologic Diagnosis of Bone and Joint Diseases. Including Gamma Correction Interpretation, 4th Revised and Enlarged Edition. Seoul, Springer; 2013:119-39.
59. Weissmann R, Uziel Y. Pediatric complex regional pain syndrome: a review. Pediatric Rheumatol 2016; 14:29.
60. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004; 292:2388-95.
61. Manchikanti L, Hirsch JA. Clinical management of radicular pain. Expert Rev Neurother 2015; 15:681-93.
62. Sherry DD. Pain syndromes. In: Isenberg DA, Miller III JJ. Adolescent Rheumatology. London, Martin Dunitz, 1999:197-227.
2. Burke MG. Extremity pain. In: Hoekelmann RA, Friedman SB, Nelson NM, Seidel H, Weitzman ML. Primary Pediatric Care, 3th ed. St. Louis, Mosby; 1997:940-5.
3. De Inocencio J, Carro MA, Flores M, Carpio C, Mesa S, Marín M. Epidemiology of musculoskeletal pain in a pediatric emergency department. Rheumatol Int 2016; 36:83-9.
4. Guimarães CV, Pedroso H, Conde M. Artralgia. In: Pedroso H, Martins S. Abordagem em consulta de pediatria, da criança ao adolescente. Lisbon, Bene Farmacêutica, 2015:96-9.
5. Sawyer SS. Examination of the musculoskeletal system. In: Sawyer SS. Pediatric Physical Examination & Health Assessment. Sudbury, Jones & Bartlett Learning; 2012:421-501.
6. Lehman TJA. In: Juvenile Arthritis. Lehman TJA. A Clinician’s Guide to Rheumatic Diseases in Children. New York, Oxford University Press; 2009:90-124.
7. Melo Gomes JA. A criança com Doença Reumática. In: Palminha JM, Carrilho EM. Orientação Diagnóstica em Pediatria. Dos sinais e sintomas ao diagnóstico diferencial. Lisbon, Lidel; 2003:849-90.
8. Rovenský J, Payer J. Dictionary of Rheumatology. Vienna, Springer; 2009.
9. Laxer RM, Wright J, Lindsley CB. Infectious Arthritis and Osteomyelitis. In: Petty R, Laxer R, Lindsley C, Wedderburn L. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Elsevier; 2016:533-50.
10. Petty R, Laxer R, Wedderburn L. Juvenile Idiopathic Arthritis. In: Petty R, Laxer R, Lindsley C, Wedderburn L. Textbook of Pediatric Rheumatology, 7th ed. Philadelphia, Elsevier; 2016:188-204.
11. Laxer RM, Sherry DD, Hashkes PJ. Juvenile Idiopathic Arthritis (JIA). In: Laxer RM, Sherry DD, Hashkes PJ. Pediatric Rheumatology in Clinical Practice. 2nd ed. Toronto, Springer; 2016:31-62.
12. Salgado M. As “Dores de crescimento” na criança. In: Pedroso H, Martins S. Abordagem em consulta de pediatria, da criança ao adolescente. Lisboa, Bene Farmacêutica; 2015:93-5.
13. Mohanta MP. Growing pains: Pratitioners’ dilemma. Indian Peditr 2014; 51:379-83.
14. Staheli LT. Fundamentals of Pediatric Orthopedics. 5th ed. Seatle, Wolters Kluwer; 2016.
15. Herring JA. Tachdjian’s Pediatric Orthopaedics. From the Texas Scottish Rite Hospital for Children. 5th ed. Philadelphia, Elsevier Saunders; 2014.
16. Seabra JF. Ortopedia Infantil - O Fundamental. Coimbra, ASIC; 2016.
17. Jacobs JC. Differential Diagnosis of Arthritis in Childhood. In: Jacobs JC. Pediatric Rheumatology for the Practitioner, 2nd ed. New York, Springer-Verlag; 1993:25-230.
18. Spencer CH, Patwardhan A. Pediatric rheumatology for the primary care clinicians-recognizing patterns of disease. Curr Probl Pediatr Adolesc Heath Care 2015; 45:185-206.
19. Foster H, Jandial S. Clinical Examination of the Child with a Rheumatic Disease. In: Sawhney S, Aggarwal A. Pediatric Rheumatology. A Clinical Viewpoint. Singapore, Springer; 2017:89-105.
20. Haines KA. The approach to the child with joint complaints. Ped Clin N Amer 2018; 65:623-38.
21. Weiss JE, Stinson JN. Pediatric pain syndromes and noninflammatory musculoskeletal pain. Ped Clin N Amer 2018; 65:801-26.
22. Davies K, Coperman A. The spectrum of paediatric and adolescent rheumatology. Best Pract Res Clin Rheumatol 2006; 20:179-200.
23. da Silva JA, Woolf AD. Rheumatology in Practice. London, Springer-Verlag; 2010.
24. Murias Loza S, Remesal Camba A, Alcobendas Rueda R. Artritis. In: Guerrero-Fenández J, Cartón Sánchez AJ, Borreda Bonis AC, Menéndez Suso JJ, Ruiz Domínguez JA. Manual de Diagnóstico y Terapéutica en Pediatria. Buenos Aires, Editorial Medica Panamericana; 2018:2081-9.
25. del Moral OM, Salvat IS, Ibarra JM, Cuenca JM. El síndrome de dolor miofascial y los puntos gatillo miofasciais. In: del Moral OM, Salvat IS. Fisioterapia Invasiva del Síndrome de Dolor Miofascial. Manual de punción seca de puntos gatillo. Buenos Aires, Editorial Médica Panamericana; 2017:3-25.
26. Angus-Leppan H, Guiloff RJ. Familial limb pain and migraine: 8-year follow-up of four generations. Cephalagia 2016; 36:1086-93.
27. Carapetis JR, Currie BJ. Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Arch Dis Child 2001; 85:223-7.
28. Mistry RM, Lennon D, Boyle MJ, et al. Septic arthritis arthritis and acute rheumatic fever in children. J Pediatr Orthop 2014; 35:318-22.
29. Ferguson PJ, Laxer RM. Autoinflammatory bone disorders. In: Petty R, Laxer R, Lindsley C, Wedderburn L. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia, Elsevier; 2016:627-41.
30. Weisman SJ. Multidisciplinary approaches to chronic pain. In: Walco GA, Goldschneider KR, Pain in Children. A Practical Guide for Primary Care. Totowa, Humana Press; 2008:133-43.
31. Schmidt RF, Gebhart GF. Encyclopedia of Pain, 2nd ed. Heidelberg, Springer; 2013.
32. Fernández-de-las-Peñas C, Arendt-Nielsen L. Myofascial pain and fibromyalgia: two different but overlapping disorders. Pain Manag 2016; 6:401–8.
33. Simpson DM, McArthur JC, Dworkin RH. Neuropathic Pain: Mechanisms, Diagnosis and Treatment. Oxford, Oxford University Press; 2012.
34. Prashanth GP, Bhandankar M, Patil VD. Migratory polyarthritis as a paraneoplastic syndrome in childhood leukemia. Rheumatol Int 2013; 33:1647-8.
35. Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the american heart association. Circulation 2015; 131:1806-18.
36. Sanmarti R, Salvador G. Palindromic rheumatism and other relapsing arthritis. Best Pract Res Clin Rheumatol 2004; 18:647-61.
37. Cabrera-Villalba S, Sanmarti R. Palindromic rheumatism: a reppraisal. Int J Clin Rheumatol 2013; 8:569-77.
38. Merskey H, Bogduk, N. Part III: Pain Terms: A Current List with Definitions and Notes on Usage. In: IASP Task Force on Taxonomy. Classification of Chronic Pain, Second Edition (Revised). Washington, International Association for the Study of Pain; 2012.
39. Rodrigues AC, Kang PB. Neuropathic and myopathic pain. Sem Pediatr Neurol 2016;23:242-7.
40. Terreri MTRA, Len CA, Hilário MO, Ishida A, Pinto JA, Kuwajima SS. Locomotor. In: Puccini RF, Hilário MO. Semiologia da Criança e do Adolescente. Rio de Janeiro, Guanabara Koogan, 2008:220-38.
41. Sherry DD, Bohnsack J, Salmonson K, Wallace CA, Mellins E. Painless juvenile rheumatoid arthritis. J Pediatr 1990; 116:921-3.
42. Foster HE, Eltringham MS, Kay LJ, Friswell M, Abinun M, Myers A. Delay in acess to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis. Arthr Rheum 2007; 57:921-7.
43. McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics 2002; 110:354-9.
44. Leet AI, Skaggs DL. Evaluation of the acutely limping child. Am Fam Physician 2000; 61:1011-8.
45. Naranje S, Kelly DM, Sawyer JR. A systematic approach to the evaluation of a limping child. Am Fam Physician 2015; 92:908-16.
46. Hills BA, Thomas K. Joint stiffness and “articular gelling”: inhibition of the fusion of articular surfaces by surfactant. Br J Rheumatol 1998; 37:532-8.
47. Leung AKC, Wong BE, Chang PY, Cho HY. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc 1999; 91:329-32.
48. Leung AKC, Wong BE. Leg cramps in children. Clin Pediatr (Phila) 1997; 36:69-73.
49. Matthews E, Silwal A, Sud R, Hanna MG, Manzur AY, Muntoni F, et al. Skeletal muscle channelopaties: rare disorders of common pediatric syymptoms. J Pediatr 2017; 188:181-5e6.
50. Quinlivan R, Jungbluth H. Myopathic causes of exercise intolerance with rhabdomyolysis. Dev Med Child Neurol 2012; 54:886-91.
51. Scott DL, Khoshaba B, Choy EH, Kingsley GH. Limited correlation between the health assessment questionnaire (HAQ) and EuroQol in rheumatoid arthritis: questionable validity of deriving quality adjusted life years from HAQ. Ann Rheum Dis 2007; 66:1534-7.
52. Mosek A. The Medical Evaluation of Pain. In: Kreitler S, Beltrutti D. The Handbook of Chronic Pain. New York, Nova Science Publishers; 2007:145-51.
53. Arendt-Nielsen L, Svensson P. Referred muscle pain: basic and clinical findings. Clin J Pain 2001; 17:11-9.
54. Madden S, Kelly L. Update on acute rheumatic fever: it still exists in remote communities. Can Fam Physician 2009; 55:475-8.
55. Butbul-Aviel Y, Uziel Y, Hezkelo N, Brik R, Amarilyo G. Is palindromic rheumatism amongst children a benign disease? Pediatr Rheumatol Online J 2018; 16:12.
56. Sreenivas T, Nataraj AR, Meno J, Patro DK. Acute multifocal haematogenous osteomyelitis in children. J Child Orthop 2011; 5:231-5.
57. Perlman MH, Patazakis MJ, Kumar PJ, Holtom P. The incidence of joint involvement with adjacent osteomyelitis in pediatric
patients. J Pediatr Orthop 2000; 20:40-3.
58. Bahk Y-W. Diseases of Joints and Soft-Tissue Infections. In: Bahk Y-W. Combined Scintigraphic and Radiologic Diagnosis of Bone and Joint Diseases. Including Gamma Correction Interpretation, 4th Revised and Enlarged Edition. Seoul, Springer; 2013:119-39.
59. Weissmann R, Uziel Y. Pediatric complex regional pain syndrome: a review. Pediatric Rheumatol 2016; 14:29.
60. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004; 292:2388-95.
61. Manchikanti L, Hirsch JA. Clinical management of radicular pain. Expert Rev Neurother 2015; 15:681-93.
62. Sherry DD. Pain syndromes. In: Isenberg DA, Miller III JJ. Adolescent Rheumatology. London, Martin Dunitz, 1999:197-227.
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2019-12-16
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Fernandes MA, de Melo I, Costa FC, Salgado M. Definição e caraterização de dor musculoesquelética e doenças associadas. REVNEC [Internet]. 16 de Dezembro de 2019 [citado 28 de Outubro de 2024];28(4):203-15. Disponível em: https://revistas.rcaap.pt/nascercrescer/article/view/15457
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