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Septic Arthritis and Acute Rheumatic Fever in Children: The Diagnostic Value of Serological Inflammatory Markers.
[acute rheumatic fever]
Joint
pain
and
raised
inflammatory
markers
are
features
of
both
acute
rheumatic
fever
(
ARF
)
and
septic
arthritis
,
often
posing
a
diagnostic
challenge
to
clinicians
.
Important
differences
in
the
presenting
serological
inflammatory
marker
profile
may
assist
patient
diagnosis
,
however
,
as
clinical
experience
suggests
that
ARF
is
associated
with
a
higher
erythrocyte
sedimentation
rate
(
ESR
)
,
whereas
other
serological
markers
may
be
similarly
elevated
in
these
2
conditions
.
The
goal
of
this
study
was
to
determine
the
diagnostic
value
of
serological
inflammatory
markers
and
white
cell
count
(
WCC
)
in
children
presenting
with
acute
joint
pain
secondary
to
ARF
or
septic
arthritis
.
Data
were
obtained
from
the
Auckland
regional
rheumatic
fever
database
and
hospital
computer
records
between
2005
and
2012
.
Records
of
all
patients
under
the
age
of
16
years
who
were
admitted
with
a
new
diagnosis
of
ARF
or
septic
arthritis
were
analyzed
.
The
diagnosis
of
ARF
was
defined
on
the
basis
of
the
New
Zealand
modification
of
the
Jones
Criteria
,
and
the
diagnosis
of
septic
arthritis
was
defined
on
the
basis
of
joint
fluid
cytology
and
culture
.
Baseline
characteristics
,
serological
inflammatory
markers
,
and
serum
WCC
were
compared
between
the
ARF
and
septic
arthritis
patient
groups
.
Children
with
ARF
displayed
significantly
higher
ESR
,
higher
serum
C-
reactive
protein
,
and
lower
serum
WCC
than
children
with
septic
arthritis
on
presentation
to
hospital
.
In
children
presenting
with
monoarthritis
,
an
ESR
>
64
.
5
,
serum
WCC
<
12
.
1
×
109
/
L
,
and
age
above
8
.
5
years
were
found
to
be
significant
independent
predictors
of
ARF
.
Children
with
all
3
predictors
had
a
71
%
risk
for
ARF
and
a
29
%
risk
for
septic
arthritis
.
A
significant
proportion
(
30
%
)
of
children
with
the
final
diagnosis
of
ARF
initially
presented
with
monoarthritis
;
14
%
of
these
children
(
5
/
34
)
had
received
nonsteroidal
anti-
inflammatory
medication
before
hospital
presentation
,
and
74
%
of
these
children
(
25
/
34
)
had
abnormal
echocardiograms
on
admission
.
ARF
and
septic
arthritis
are
important
diagnoses
to
consider
in
children
presenting
with
acute
joint
pain
in
New
Zealand
.
A
significant
proportion
of
patients
with
ARF
initially
present
with
acute
monoarthritis
.
Serological
inflammatory
markers
and
WCC
on
presentation
differ
significantly
between
children
with
ARF
and
septic
arthritis
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated
