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Diseases » Arthrogryposis » Diagnosis

Diagnosis of Arthrogryposis

Arthrogryposis Diagnosis: Book Excerpts

Differential Diagnosis - Arthritis – Multiple Joints

Diagnostic Tests for Arthrogryposis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Arthrogryposis.

Arthritis – Multiple Joints: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Infectious
–Reactive arthritis (postenteric or genital including Reiter syndrome, postviral, poststreptococcal)
–Acute rheumatic fever (ARF): Migratory, painful; usually affects large joints; diagnosis is based on Jones criteria, which includes five major (arthritis, carditis, Sydenham chorea, erythema marginatum, subcutaneous nodules) and several minor (fever, arthralgia, elevated ESR or CRP, prolonged P-R interval) manifestations
–Lyme disease: Arthritis is monoarticular or oligoarticular, is rarely symmetric, and is the second most common manifestation of Lyme disease after erythema migrans
–SBE-related arthritis
–Septic polyarthritis (unusual)

Rheumatic
–Polyarticular JRA: Arthritis in five or more joints in first 6 months of disease, insidious onset, symmetric involvement, may be RF+ (erosive, similar to adult RA) or RF-
–Systemic-onset JRA: Presents with severe systemic involvement (fever, rash, serositis), which may precede the arthritis, usually oligoarticular
–Juvenile ankylosing spondylitis (JAS): Initially affects lower extremity joints; later affects axial skeleton, also affects tendons
–Psoriatic arthritis
–Arthritis of IBD: Usually more transient than JRA
–SLE: May present only with arthritis, may be misdiagnosed as JRA
–Other connective tissue diseases (scleroderma)
–Vasculitis (HSP, Kawasaki disease)

Malignancy such as leukemia
Other systemic disorders: Serum sickness, sarcoidosis, Behçet disease, Ehler-Danlos syndrome, mucopolysaccharidoses, Noonan syndrome, Turner syndrome
Medications (minocyline, carbamazapine)
Sickle cell disease

Workup and Diagnosis

History
–Acute or chronic; persistent or intermittent; degree of pain, night-time symptoms
–Systemic symptoms such as fever, weight loss, rash, and fatigue
–Mouth and/or genital ulcers, abdominal pain, vomiting, diarrhea, bloody stools
–Past medical history: Birth history, existing medical conditions, surgeries, broken bones, growth and development, any recent URI, genital infection or strep infection, unusual exposures such as tick bites

Physical exam
–Vital signs including growth parameters
–Musculoskeletal exam for swelling, tenderness, warmth, redness over the joints, range of motion of the joints; asymmetry, muscle strength
–Lympadenopathy, organomegaly, rash, dysmorphic features, presence of bone pain and neurologic exam (tone, sensory, and reflexes)

Labs: CBC, ESR or CRP, RF and ANA; Lyme titers, lupus panel, complement (C3, C4) levels; viral titers (HCV, EBV, parvovirus), LDH, U/A, LFTs
Radiology: CXR, X-ray of involved joints, US, MRI, and bone scan to rule out infection, malignancy, and to confirm effusion and tenosynovitis
Studies: ECG, echocardiogram, angiogram, UGI/SBF, endoscopy when clinically indicated

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Source: In A Page: Pediatric Signs and Symptoms, 2007