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migratory arthritis
Etiology:
- disseminated gonococcal infection
- Lyme disease
- acute rheumatic fever
- adult-onset Still's disease
Clinical manifestations:
1) asymmetric
2) generally oligoarthritis
Laboratory:
1) arthrocentesis & joint fluid culture
2) blood culture for disseminated infection a in disseminated gonococcal infection, obtain specimens from cervix, urethra, oropharynx & rectum & test for N gonorrhoeae (see gonorrhea)
b) if N gonorrhoeae confirmed, test for Chlamydia, syphilis, & HIV
c) rule out endocarditis (rheumatic fever)
3) serology for Lyme disease
a) IgM appears 4 weeks after exposure
b) IgG appears 6-8 weeks after exposure
c) indicated for early disseminated & late Lyme disease, not indicated for acute (early) localized Lyme disease
4) antistreptolysin O (ASO) titer (rheumatic fever)
5) erythrocyte sedimentation rate & C-reactive protein are markers of inflammation
4) throat culture for Streptococcus (rheumatic fever)
Special laboratory:
- EKG (PR prolongation in rheumatic fever)
- echocardiogram (rheumatic fever)
Radiology:
- chest X-ray to rule out cardiomegaly (rheumatic fever)
Management:
- dependent upon etiology
General
arthritis
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 18.
American College of Physicians, Philadelphia 2009, 2018.