15. Etiology and differential diagnosis of joint pain.

Page created on February 14, 2022. Not updated since.

Evaluation

Infectious causes of arthritis require urgent diagnosis and management. For this reason, joint aspiration should be performed in case of patients with fever, elevated inflammatory parameters, and features of infection (warmth, erythema).

Differential diagnosis of monoarticular arthritis

Etiology Typical features
Septic arthritis Fever, unwell child, erythema, warmth, swelling, tenderness, WBCs and bacteria in joint aspirate
Osteomyelitis Fever, unwell child, erythema, warmth, swelling, tenderness, positive MRI
Haemarthrosis (trauma, bleeding disorder) Bruising, known or family history of bleeding disorder
Acute leukaemia, other malignancies Anaemia, skin bleedings, infections
Reactive arthritis Recent infection (chlamydia, salmonella), conjunctivitis
Bone tumour (osteoid osteoma, etc.) Pain at night

Differential diagnosis of polyarticular arthritis

Etiology Typical features
SLE Generalised lymphadenopathy, butterfly rash, photosensitivity
HSP Purpuric rash on butt and extensor surfaces, spares the trunk. Abdominal pain
JIA No erythema, stiffness after periods of rest and in the morning
Reactive arthritis Recent infection (chlamydia, salmonella), conjunctivitis
Lyme disease Erythema migrans, fever, malaise, myalgia
IBD GI symptoms, skin symptoms
Malignancy General symptoms of malignancy

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