How does the number of affected joints help in sorting through the differential diagnosis of arthritis

How does the number of affected joints help in sorting through the differential diagnosis of arthritis?

Factors helpful in assessing the etiology of arthritis are the duration of disease at the time the child is evaluated, the sex and age of the child, and the onset type and pattern of joint involvement. The differential diagnosis of polyarthritis is considerably different from that of monoarthritis or oligoarthritis. JIA is the most common cause of chronic monoarthritis, especially in girls aged <5 years.

Causes of Acute and Chronic Monoarthritis and PolyarthritisAdapted from Cassidy JT, et al: Textbook of Pediatric Rheumatology, 6th ed. Philadelphia, WB Saunders, 2011.

Acute monoarthritisChronic monoarthritis
Early rheumatic diseaseJIAPolyarticular JIA (RF+, RF–)
Oligoarticular JIAERAJuvenile psoriatic arthritis
ERAJuvenile psoriatic arthritisSLE
Arthritis related to infectionOligoarticularMCTD
Septic arthritisSarcoidosisSjogren syndrome
Reactive arthritisInfectionPolyarthritis related to infection
Lyme diseaseTuberculosisRheumatic fever
MalignancyLyme diseaseReactive arthritis
LeukemiaHemarthrosisLyme disease (rarely)
HemophiliaHemophiliaPseudorheumatoid chondrodysplasia
Synovial chondromatosis
Internal derangement
Lipomatosis arborescens

ERA, enthesitis-related arthritis; JIA, juvenile idiopathic arthritis; MCTD, mixed connective tissue disease; PVNS, pigmented villonodular synovitis; RF, rheumatoid factor; SLE, systemic lupus erythematosus.


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