Approach to the Child with Joint Inflammation

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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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References (40)

  • K. Oen et al.

    Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: results of a Canadian multicenter, prospective inception cohort study

    Arthritis Rheum

    (2009)
  • I. Kunnamo et al.

    Clinical signs and laboratory tests in the differential diagnosis of arthritis in children

    Am J Dis Child

    (1987)
  • C.L. Wang et al.

    Septic arthritis in children: relationship of causative pathogens, complications, and outcome

    J Microbiol Immunol Infect

    (2003)
  • M.S. Kocher et al.

    A clinical practice guideline for treatment of septic arthritis in children: efficacy in improving process of care and effect on outcome of septic arthritis of the hip

    J Bone Joint Surg Am

    (2003)
  • J. Cassidy et al.

    Textbook of pediatric rheumatology

    (2011)
  • G. Dubnov-Raz et al.

    Invasive pediatric Kingella kingae infections: a nationwide collaborative study

    Pediatr Infect Dis J

    (2010)
  • P. Yagupsky et al.

    Kingella kingae: an emerging pathogen in young children

    Pediatrics

    (2011)
  • American Academy of Pediatrics

    Summary of Major Changes in the 2009 Red Book

  • N. Cimolai et al.

    Mycoplasma pneumoniae associated arthropathy: confirmation of the association by determination of the antipolypeptide IgM response

    J Rheumatol

    (1989)
  • T. Hannu et al.

    Chlamydia pneumoniae as a triggering infection in reactive arthritis

    Rheumatology

    (1999)
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