Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis

Thomas, Marion L.; Bonacorsi, Stéphane; Simon, Anne-Laure; Mallet, Cindy; Lorrot, Mathie; Faye, Albert; Dingulu, Glory; Caseris, Marion; Boneca, Ivo Gomperts; Aupiais, Camille; Meinzer, Ulrich

doi:10.1038/s41598-021-82553-1

Cited by 16 publications

(15 citation statements)

References 37 publications

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“…Synovial fluid analysis usually reveals a white blood cell count (WBC) of more than 50,000 cells/microL, with a predominance of polymorphonuclear leukocytes. In the aforementioned cohort of 196 pediatric patients with monoarthritis, WBC count > 50,000 cells/mm 3 was found in 72.7% of patients with septic arthritis, more frequently compared to JIA (44.4%) and undefined arthritis (34.6%) [1]. Other studies in the literature confirm the same data, also in adult populations [20,21].…”

Section: Introductionsupporting

confidence: 70%

“…In a recent report by Thomas et. al.,196 patients aged between 3 months and 6 years with acute monoarticular inflammation were evaluated: 56.1% had a septic arthritis, 10.2% had onset of juvenile idiopathic arthritis, and for 33.7% no definitive diagnosis was possible [1].…”

Section: Introductionmentioning

confidence: 99%

“…Kingella kingae, a Gram-negative bacterium, is an emerging pathogen representing in some series over 80% of the causes in patients between 28 days and 4 years of age. [1,6]. Samara et al compared bacteriologic data of patients with osteoarticular infections over 20 years, dividing them in two groups before and after the extensive use of nucleic acid amplification assays in the diagnostic process.…”

Section: Introductionmentioning

confidence: 99%

“…Blood tests are the very first actions to take when septic arthritis is suspected. Thomas et al found that CRP levels, hemoglobin, and WBC counts were significantly different in patients with septic arthritis compared to those ones with juvenile idiopathic arthritis and undefined arthritis [1]. Moreover, CRP is an excellent negative predictor factor for septic arthritis and is more used in clinical practice compared to ESR [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…Although laboratory tests are mandatory, it has been demonstrated that in children less than 6 years of age with acute monoarthritis, the clinical and biological parameters currently used do not reliably differentiate between septic arthritis and JIA or undifferentiated arthritis, and often only evolution can differentiate them [1]. In fact, in case of increased WBC, ESR, and CRP that could be elevated both in septic and inflammatory arthritis, the response to antibiotic drugs and the evolution within the first 48 h will guide the clinician to confirm the correct diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

et al. 2021

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The term septic arthritis refers to an infection of the synovial space. This is an infrequent condition in healthy children, but it should be considered a medical emergency potentially leading to irreversible articular damage. Therefore, prompt diagnosis and antimicrobial treatment play a crucial role in improving the prognosis. Although septic arthritis is the most common cause of acute arthritis, many other diseases may mimic a similar clinical picture, constituting a diagnostic challenge for the clinician who first approaches the patient. Herein we analyze the main features of septic arthritis, offering an overview of the main conditions involved in the differential diagnosis and suggesting a diagnostic workup plan.

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Section: Introductionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

et al. 2021

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Etiology of septic arthritis in children of Qatar

Khan,

Elsheikh,

Alansari

2024

JACEP Open

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ObjectiveSeptic arthritis is an orthopedic emergency and if not evaluated and treated appropriately, it can lead to poor clinical outcomes. Previously several studies have been performed to identify the etiology of septic arthritis in the pediatric population in developed countries. The main objective of our study was to identify the etiology of septic arthritis in children in Qatar in previously healthy and fully vaccinated children.MethodsWe performed retrospective chart analysis of children presenting to our emergency department between July 2018 and June 2024, who were diagnosed and treated with septic arthritis. The study was conducted at a level 1 pediatric trauma center and the only children's hospital in the country. We used ICD 9 and ICD 10 codes to identify such cases. After using predefined exclusion criteria, children with positive blood cultures, blood titers for Brucella and/or synovial cultures were included in the analysis. Clinical symptoms and signs, ultrasound findings, and culture results were tabulated using descriptive statistics.ResultsA total of 45 patients were included. The median age of children was 5 years (interquartile range [IQR] 2–10 years). Majority (60%) were male. The most common clinical findings were limping/limitation of joint movement (100%), fever (80%), and swelling of joints (58%). The median C‐reactive protein and erythrocyte sedimentation rate were 94 mg/L and 47 mm/h. The knee and hip were the most common joints affected. The most common causative organisms were Staphylococcus aureus (56%), Streptococcus pyogenes (13%), and Brucella (11%). Pre‐intervention imaging, such as ultrasound and/or magnetic resonance imaging, was performed in 95% of patients. All patients recovered without any complications. One of the limitations of our study is that cases of Kingella kingae septic arthritis may be underreported as polymerase chain reaction (PCR) analysis of synovial fluid was not performed on all patients.ConclusionGram‐positive cocci, especially S. aureus, remains the most common cause of septic arthritis in vaccinated children. We also identified Gram‐negative bacilli as causative organisms in our study. We suggest including empiric coverage for both Gram‐ and Gram‐negative bacilli when treating children with suspected septic arthritis till culture results are available.

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Genicular nerve block in juvenile idiopathic arthritis: a randomized clinical trial

et al. 2022

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Objectives This study aimed at evaluating the effect of genicular nerve block (GNB) in juvenile idiopathic arthritis (JIA) patients with persistent unilateral knee arthritis on pain, inflammatory parameters, function, and range of motion. Methods A total of 104 JIA patients were diagnosed according to the International League Against Rheumatism (ILAR) criteria with persistent unilateral knee arthritis. They were allocated randomly into 2 groups: group 1 treated with GNB, while group 2 was treated with intra-articular triamcinolone (TA) only. Visual analogue scale (VAS) on pain, sonography of large joints in rheumatology (SOLAR) scoring system, and Lysholm scores were assessed at 0-, 2-, and 12-week intervals. Swelling and tenderness were clinically evaluated semi-quantitatively (0-3) at the same time intervals. Results VAS pain, tenderness, swelling, and SOLAR grey scale (GS) and power Doppler (PD) scores were significantly reduced after 2 weeks in both groups (p < 0.05). This was greater in the GNB group regarding VAS and tenderness, while SOLAR and swelling were stronger reduced in TA group. After 12 weeks, all outcome measures showed lower values in the GNB group compared to TA, and this was significant regarding VAS pain. Moreover, Lysholm functional score was significantly increased in both groups at both intervals; and higher values were seen in the TA group compared to GNB after 2 weeks. Conclusion GNB was able to control pain and improve function and inflammation of the knee joint in JIA patients. Though steroid attained better results after 2 weeks, GNB achieved an equivalent longer-term improvement after 12 weeks. Trial registration identifying number NCT04687930. Key Points• Persistent knee arthritis treatment in JIA is always challenging.• GNB was approved for treatment of pain in knee osteoarthritis.• GNB in the present study succeeded to control active knee arthritis and this effect was comparable to intra-articular steroid injection.

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Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis

Cited by 16 publications

References 37 publications

Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

Etiology of septic arthritis in children of Qatar

Genicular nerve block in juvenile idiopathic arthritis: a randomized clinical trial

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