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Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis.
Thomas, Marion; Bonacorsi, Stephane; Simon, Anne-Laure; Mallet, Cindy; Lorrot, Mathie; Faye, Albert; Dingulu, Glory; Caseris, Marion; Boneca, Ivo Gomperts; Aupiais, Camille; Meinzer, Ulrich.
Afiliação
  • Thomas M; Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, Fr
  • Bonacorsi S; Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.
  • Simon AL; CNRS UMR2001, Paris, France.
  • Mallet C; INSERM, Equipe Avenir, Paris, France.
  • Lorrot M; Université de Paris, Paris, France.
  • Faye A; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Dingulu G; Université de Paris, Paris, France.
  • Caseris M; Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Boneca IG; Université de Paris, Paris, France.
  • Aupiais C; Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Meinzer U; Pediatric Department, Division of Infectious Diseases, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Sci Rep ; 11(1): 3422, 2021 02 09.
Article em En | MEDLINE | ID: mdl-33564018
Acute arthritis is a common cause of consultation in pediatric emergency wards. Arthritis can be caused by juvenile idiopathic arthritis (JIA), septic (SA) or remain undetermined (UA). In young children, SA is mainly caused by Kingella kingae (KK), a hard to grow bacteria leading generally to a mild clinical and biological form of SA. An early accurate diagnosis between KK-SA and early-onset JIA is essential to provide appropriate treatment and follow-up. The aim of this work was to compare clinical and biological characteristics, length of hospital stays, duration of intravenous (IV) antibiotics exposure and use of invasive surgical management of patients under 6 years of age hospitalized for acute monoarthritis with a final diagnosis of JIA, SA or UA. We retrospectively analyzed data from < 6-year-old children, hospitalized at a French tertiary center for acute mono-arthritis, who underwent a joint aspiration. Non-parametric tests were performed to compare children with JIA, SA or UA. Bonferroni correction for multiple comparisons was applied with threshold for significance at 0.025. Among the 196 included patients, 110 (56.1%) had SA, 20 (10.2%) had JIA and 66 (33.7%) had UA. Patients with JIA were older when compared to SA (2.7 years [1.8-3.6] versus 1.4 [1.1-2.1], p < 0.001). Presence of fever was not different between JIA and SA or UA. White blood cells in serum were lower in JIA (11.2 × 109/L [10-13.6]) when compared to SA (13.2 × 109/L [11-16.6]), p = 0.01. In synovial fluid leucocytes were higher in SA 105.5 × 103 cells/mm3 [46-211] compared to JIA and UA (42 × 103 cells/mm3 [6.4-59.2] and 7.29 × 103 cells/mm3 [2.1-72] respectively), p < 0.001. Intravenous antibiotics were administered to 95% of children with JIA, 100% of patients with SA, and 95.4% of UA. Arthrotomy-lavage was performed in 66.7% of patients with JIA, 79.6% of patients with SA, and 71.1% of patients with UA. In children less than 6 years of age with acute mono-arthritis, the clinical and biological parameters currently used do not reliably differentiate between JIA, AS and UA. JIA subgroups that present a diagnostic problem at the onset of monoarthritis before the age of 6 years, are oligoarticular JIA and systemic JIA with hip arthritis. The development of new biomarkers will be required to distinguish JIA and AS caused by Kingella kingae in these patients.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artrite Juvenil / Artrite Infecciosa / Infecções por Neisseriaceae / Kingella kingae Limite: Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: Europa Idioma: En Revista: Sci Rep Ano de publicação: 2021 Tipo de documento: Article País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artrite Juvenil / Artrite Infecciosa / Infecções por Neisseriaceae / Kingella kingae Limite: Child / Child, preschool / Female / Humans / Infant / Male País/Região como assunto: Europa Idioma: En Revista: Sci Rep Ano de publicação: 2021 Tipo de documento: Article País de publicação: Reino Unido