Diff Diagnosis of the Septic Arthritis

- See: Synovial F. Exam
        - ewing's sarcoma
        - neuroblastoma
        - rheumatoid flare
        - monarticular JRA - knee is less painful, and ROM is > than expected w/ large effusion;
        - acute rheumatic fever: less frequent, more painful with less effusion;
        - toxic synovitis of the hip
        - multiple myeloma (presents w/ strep infection of knee or hip)
        - lyme disease
        - leukemia
                - An unusual orthopaedic presentation of acute lymphoblastic leukemia.
        - sickle cell crises
        - legg calve perthes disease
        - SCFE
        - gonococcal arthritis
        - adjacent osteomyelitis
        - schonlein-henoch purpura
        - hemophilia
        - gout
        - pseudogout
        - primary menigococcal arthritis:
               - is unusual disease, frequently characterized by erythematous maculopapular or petechial rash & multiple joint involvement w/ 80-90 % positive joint cultures;
               - frequently an orthopod is asked to see child w/ apparent septic joint who is 5-7 days into ATB Rx for meningo meningitis;
               - these cases often represent an Arthus reaction caused by the newly produced circulating antibodies and bacterial antigens in serum;
               - similar situation is seen following Streptococcal arthritis;

            - lyme disease
            - osteomyelitis 
            - references:
                   - Clinical features of pseudogout attack. A survey of 50 cases.
                   - Staphylococcal septic arthritis presenting as acute flare of pseudogout: clinical, pathological and arthroscopic findings with a review of the literature.
                   - Acute pseudogout mimicking septic arthritis following urologic manipulation
    - radioisotope scanning
                   - Gallium scintigraphy for diagnosis of septic arthritis and osteomyelitis in children
                   - Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, November 30, 2015 2:19 pm