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Arthritis in children: comparison of clinical and biological characteristics of septic arthritis and juvenile idiopathic arthritis
  1. Camille Aupiais1,2,3,
  2. Romain Basmaci3,4,5,
  3. Brice Ilharreborde3,6,
  4. Audrey Blachier7,
  5. Marie Desmarest8,
  6. Chantal Job-Deslandre9,10,
  7. Albert Faye2,3,4,
  8. Stéphane Bonacorsi3,5,11,
  9. Corinne Alberti1,2,3,
  10. Mathie Lorrot2,3,4
  1. 1Unité d’Epidémiologie Clinique, AP-HP, Hôpital Robert Debré, Paris, France
  2. 2Inserm, U1123, ECEVE and CIC-EC 1426, Paris, France
  3. 3Univ Denis Diderot Paris 7, Sorbonne Paris Cité, Paris, France
  4. 4Service de Pédiatrie Générale, AP-HP, Hôpital Robert Debré, Paris, France
  5. 5Inserm, UMR1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France
  6. 6Service d'Orthopédie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France
  7. 7Département Informatique Médicale, Hôpital Robert Debré (APHP), Paris, France
  8. 8Service d'Accueil des Urgences Pédiatriques, AP-HP, Hôpital Robert Debré, Paris, France
  9. 9Service de Rhumatologie, AP-HP, Hôpital Cochin, Paris, France
  10. 10Université René Descartes Paris 5, Paris, France
  11. 11Service de Microbiologie, AP-HP, Hôpital Robert Debré, Paris, France
  1. Correspondence to Dr Camille Aupiais, Unité d'Epidémiologie clinique, Hôpital Robert Debré (APHP), 48 boulevard Sérurier, Paris 75935, Cedex 19, France; camille.aupiais{at}rdb.aphp.fr

Abstract

Aim Childhood arthritis arises from several causes. The aim of this observational study is to compare the clinical and biological features and short-term outcome of different types of arthritis because they have different treatment and prognoses.

Methods Children <16 years of age hospitalised in a French tertiary care centre for a first episode of arthritis lasting for less than 6 weeks who underwent joint aspiration were retrospectively included. We performed non-parametrical tests to compare groups (septic arthritis (SA), juvenile idiopathic arthritis (JIA) and arthritis with no definitive diagnosis). The time before apyrexia or C reactive protein (CRP) <10 mg/L was analysed using the Kaplan-Meier method.

Results We studied 125 children with a sex ratio (M/F) of 1.1 and a median age of 2.2 years (range 0.3 to 14.6). SA was associated with a lower age at onset (1.5 years, IQR 1.2–3.0 vs 3.6 years, IQR 2.2–5.6), shorter duration of symptoms before diagnosis (2 days, IQR 1–4 vs 7 days, IQR 1–19) and higher synovial white blood cell count (147 cells ×103/mm3, IQR 71–227, vs 51 cells ×103/mm3, IQR 12–113), than JIA. Apyrexia occurred later in children with JIA (40% after 2 days, 95% CI 17% to 75%) than children with SA (82%, 95% CI 68% to 92%), as did CRP<10 mg/L (18% at 7 days, 95% CI 6.3% to 29.6% vs 82.1%, 95% CI 76.1% to 89.7%, p=0.01).

Conclusions There were no sufficiently reliable predictors for differentiating between SA and JIA at onset. The outcomes were different; JIA should be considered in cases of poor disease evolution after antibiotic treatment and joint aspiration.

  • Arthritis, Infectious
  • Arthritis, Juvenile
  • Child
  • Diagnosis, differential

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