February 28, 2011
School of Medicine, Kochi
An Amrita journal paper was recently published in the Indian Journal of Pediatrics.
Titled Approach to a Child with Monoarthritis, the paper was authored by A. S. Prabhu, final year postgraduate student at the Amrita School of Medicine and Suma Balan, consultant in Pediatric Rheumatology.
Before joining Amrita, Dr. Suma received training in Pediatric Rheumatology at the Nottingham Queens Medical College, United Kingdom.
The word arthritis literally means joint inflammation and derives from the Greek word arthron for joint and Latin itis for inflammation. The disease causes pain and loss of movement in the joints.
In monoarthritis, only one joint is affected. This is more common than polyarthritis, where several joints are simultaneously involved. The ailment in children may be acute, when the duration is less than three weeks or chronic, when persisting for over six weeks.
In the published paper, the authors provide a clinical approach to the diagnosis of monoarthritis in a child.
“A detailed history and clinical examination is important to reach a correct diagnosis, as there are many possibilities, both acute and chronic in nature,” they point out.
“The key point is to note that the child who presents an acute case needs urgent care to exclude septic arthritis that can destroy the joint within hours, with disastrous complications including complete destruction of the articular cartilage and epiphysis, loss of the growth plate and joint dislocation,” the authors add.
The paper discusses how inflammatory markers, antinuclear antibody testing, tests for tuberculosis and in specific cases, imaging play an important role in the diagnosis of a child with chronic monoarthritis.
The most important investigation to rule out septic arthritis in the case of acute monoarthritis is a joint aspiration, a procedure whereby a sterile needle and syringe are used to drain fluid from the joint.
The paper further discusses that the most common infecting organism for all age groups is Staphylococcus aureus. Streptococcus species, Pseudomonas aeruginosa, Pneumococci, Neisseria meningitides, Escherichia coli, Klebsiella species and Enterobacter species can cause septic arthritis.
“The joint aspiration and culture are confirmatory,” the authors explain. “It should be remembered that occasionally fluid from the joint in septic arthritis may not grow a bacterial organism, in this case, clinical suspicion will dictate that the child be treated as having septic arthritis.”
“In this case, blood cultures should be obtained to confirm the presence of bacterial infection.”
“Monoarticular juvenile rheumatoid arthritis (JIA) is essentially a diagnosis of exclusion but identification and active management of this condition helps prevent future disability,” the authors conclude.