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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.