Clinical Signs and Laboratory Tests in the Differential Diagnosis of Arthritis in Children

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

“…Furthermore, the role of the ESR may be limited because of its lack of specificity for septic arthritis. 7,8,13,14,31,32 In our patient sample, there was a large proportion (36%) of patients with septic arthritis who had jWBC less than 50,000 cells/mm 3 . The range of jWBC was quite broad, with a substantial number of patients (6 of 61 [10%]) who had counts less than 10,000 cells/ mm 3 ; the lowest jWBC was 168 cells/mm 3 .…”

“…Past studies have reported variable sensitivities of these ancillary tests for septic arthritis. The sensitivity of an elevated WBC ranges from 19% to 77%, 2,4-8,13-19,21,25-27,33 the sensitivity of an elevated ESR ranges from 71% to 94%, [2][3][4][5][6][7][8]14,15,[17][18][19][20][21]30,[33][34][35] and the sensitivity of a jWBC greater than 50,000 cells/mm 3 ranges from 0% to 92%. 1,3,[17][18][19]21,[25][26][27][28][29][30]33,36,37 Much of the literature consists of case series studies like ours, often with variable values for normal WBC, ESR, and jWBC.…”

“…In particular, the white blood cell count of the joint fluid (jWBC) is often used to help differentiate septic arthritis from other entities. Although it is known that septic arthritis is associated with elevations in WBC, ESR, and jWBC, the vast majority of the studies involve the pediatric population, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] with few studies exclusively in adults. [16][17][18][19][20][21] In addition, although several emergency medicine textbooks indicate that a jWBC greater than 50,000 cells/mm 3 is likely to be ''positive,'' the number at which a jWBC is considered ''negative'' for septic arthritis varies from 2,000 to 10,000 cells/mm 3 in different texts.…”

Juvenile idiopathic arthritis and rheumatoid arthritis: bacterial diversity in temporomandibular joint synovial fluid in comparison with immunological and clinical findings

“…CPLs may be a biological marker for the autoimmune disease activity in JIA and RA, and may also in part explain the unresponsiveness to therapy as seen in some patients with JIA and RA. Finnish study with a disease duration of chronic arthritis exceeding two weeks had low level of C-reactive protein (CRP) and an elevated IgG level and no fever (Kunnamo et al 1987), while in a Norwegian study, a high platelet count, a normal neutrophil white blood cell count, a frequent HLA-B27 association, and a positive ANA were detected (Riise et al 2008). In a recent study of long-term follow-up, physician´s global assessment, number of active joints, ESR and CRP all improved significantly from 15 to 30 years follow-up, although patient´s total assessment did not (Selvaag et al 2014).…”

Differential Diagnosis of Acute Arthritis in Children: Analysis of 126 Cases in Kuwait

“…A re cent review listed over 100 clinical condi tions in which arthritis can be a prominent feature [2]. These difficulties are particu larly pressing in a child with monoarthritis, where sepsis should receive immediate con sideration as a medico-surgical emergency [3,4], Synovial fluid analysis, the first type of investigation in adults' monoarthritis, is not easily done in children, often needing general anaesthesia [3]. In addition, clinical findings and laboratory tests have limita tions in the differentiation of joint and/or bone sepsis from viral arthritis, transient hip synovitis [1,3,5], brucella arthritis [6] and familial Mediterranean fever (FMF) ar thritis [7],…”