Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis
Open Access
- 9 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Scientific Reports
- Vol. 11 (1), 1-10
- https://doi.org/10.1038/s41598-021-82553-1
Abstract
Acute arthritis is a common cause of consultation in pediatric emergency wards. Arthritis can be caused by juvenile idiopathic arthritis (JIA), septic (SA) or remain undetermined (UA). In young children, SA is mainly caused by Kingella kingae (KK), a hard to grow bacteria leading generally to a mild clinical and biological form of SA. An early accurate diagnosis between KK-SA and early-onset JIA is essential to provide appropriate treatment and follow-up. The aim of this work was to compare clinical and biological characteristics, length of hospital stays, duration of intravenous (IV) antibiotics exposure and use of invasive surgical management of patients under 6 years of age hospitalized for acute monoarthritis with a final diagnosis of JIA, SA or UA. We retrospectively analyzed data from<6-year-old children, hospitalized at a French tertiary center for acute mono-arthritis, who underwent a joint aspiration. Non-parametric tests were performed to compare children with JIA, SA or UA. Bonferroni correction for multiple comparisons was applied with threshold for significance at 0.025. Among the 196 included patients, 110 (56.1%) had SA, 20 (10.2%) had JIA and 66 (33.7%) had UA. Patients with JIA were older when compared to SA (2.7 years [1.8-3.6] versus 1.4 [1.1-2.1], p<0.001). Presence of fever was not different between JIA and SA or UA. White blood cells in serum were lower in JIA (11.2x10(9)/L [10-13.6]) when compared to SA (13.2x10(9)/L [11-16.6]), p=0.01. In synovial fluid leucocytes were higher in SA 105.5x10(3) cells/mm(3) [46-211] compared to JIA and UA (42x10(3) cells/mm(3) [6.4-59.2] and 7.29x10(3) cells/mm(3) [2.1-72] respectively), p<0.001. Intravenous antibiotics were administered to 95% of children with JIA, 100% of patients with SA, and 95.4% of UA. Arthrotomy-lavage was performed in 66.7% of patients with JIA, 79.6% of patients with SA, and 71.1% of patients with UA. In children less than 6 years of age with acute mono-arthritis, the clinical and biological parameters currently used do not reliably differentiate between JIA, AS and UA. JIA subgroups that present a diagnostic problem at the onset of monoarthritis before the age of 6 years, are oligoarticular JIA and systemic JIA with hip arthritis. The development of new biomarkers will be required to distinguish JIA and AS caused by Kingellakingae in these patients.This publication has 41 references indexed in Scilit:
- Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unitClinical Microbiology & Infection, 2013
- Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unitClinical Microbiology & Infection, 2012
- Predictors of Hip Disease in the Systemic Arthritis Subtype of Juvenile Idiopathic ArthritisThe Journal of Rheumatology, 2011
- New Real-Time PCR-Based Method for Kingella kingae DNA Detection: Application to Samples Collected from 89 Children with Acute ArthritisJournal of Clinical Microbiology, 2009
- Infections ostéoarticulaires : propositions thérapeutiques du Groupe de Pathologie Infectieuse Pédiatrique (GPIP) de la Société Française de PédiatrieArchives de Pédiatrie, 2008
- Peptidoglycan detection by mammals and fliesMicrobes and Infection, 2007
- Arthrites juvéniles idiopathiquesEMC - Appareil Locomoteur, 2007
- Patients with juvenile psoriatic arthritis comprise two distinct populationsArthritis & Rheumatism, 2006
- Bacterial components in the synovial tissue of patients with advanced rheumatoid arthritis or osteoarthritis: Analysis with gas chromatography‐mass spectrometry and pan‐bacterial polymerase chain reactionArthritis Care & Research, 2003
- Approaching the Asymptote? Evolution and Revolution in ImmunologyCold Spring Harbor Symposia on Quantitative Biology, 1989