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

Abstract

In this retrospective study of 126 children with acute arthritis admitted to Mubarak Al-Kabeer Hospital over a 2-year period, diagnoses were viral-related arthritis in 26%, sepsis 16%, rheumatic fever 15%, transient hip synovitis 13%, connective tissue disease 11%, Henoch-Schoenlein purpura 8% and other diagnoses 14%. This pattern is more representative of general hospitals than rheumatology clinics. Polyarthritis patients did not represent a medical emergency or diagnostic difficulties. In 74 children who presented with monoarthritis, 64 were admitted as possible sepsis, proven in only 20 cases. Familial Mediterranean fever and brucella arthritis presented special problems of differential diagnosis; the most helpful findings were ill health, high fever, point tenderness and positive C-reactive protein. Neutrophil leucocytosis and high erythrocyte sedimentation rate were not as helpful.