Approach to the Child with Joint Inflammation
Section snippets
Monoarthritis
The differential diagnosis of monoarthritis includes entities in the broad categories of infection, postinfection, inflammation, malignancy, and trauma related to a systemic illness (Table 1). A carefully conducted history taking and physical examination are the initial and most important steps in narrowing the differential diagnosis and guiding the diagnostic evaluation.
Polyarthritis
The differential diagnosis of polyarthritis essentially includes infectious, inflammatory, and malignant causes (Table 2). Although mechanical causes (eg, hypermobility and skeletal dysplasia) and diffuse idiopathic pain syndromes are considered in the differential diagnosis of polyarthralgia, they do not routinely cause polyarthritis. The review of systems and physical examination is critical to establishing a diagnosis because there are clues in the characteristics of the arthritis, fever,
Summary
The differential diagnosis for monoarthritis and polyarthritis is broad. An organized approach within the framework presented, including carefully attending to clues in the history taking and physical examination allows for correct diagnosis in most cases. Laboratory evaluation is performed to support the clinician's impression. Serious and/or potentially life-threatening infectious, malignant, or orthopedic causes need to be identified, and the patient is referred for surgical or medical
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