Table 313 Investigations for arthritis

Appropriate tests can be selected from the following:

• urine analysis: blood, protein, sugar

• synovial fluid: analysis, culture

• blood and other cultures

• haemoglobin and differential white cell count

• erythrocyte sedimentation rate (ESR)

• C-reactive protein

• serum uric acid, creatinine

• 24-hour urinary uric acid

• rheumatoid factor

• antinuclear antibody (screening test for SLE)

• double strand DNA antibodies

• HLA-B27 (poor predictive value)

• various specific serological tests, e.g. Australian epidemic polyarthritis, rubella, Lyme disease, hepatitis B, Barmah Forest virus

• antistreptolysin O titre

• streptococcal anti DNAse B

• streptococcal AHT

• arthroscopy and biopsy

It is important to keep in mind the many specific serological tests to detect infective causes of arthralgia. These include Australian epidemic polyarthritis, Lyme disease, rubella, brucella, hepatitis B, gonococcus, mycoplasma, HIV tests.

Plain X-ray is invaluable, although in some conditions radiological changes may be apparent only when the disease is well established. Typical X-ray changes for common conditions are presented in Figure 31.3 . Arthrography has limited value in the diagnosis of polyarthritis but is very useful for specific joints such as the shoulder and the knee. Ultrasound examination for joints such as the shoulder and the hip can be very useful.

NuriTia! joint

NuriTia! joint

Rheumatoid arthritis


joint destruction subluxation erosion jomt margins osteoporosis periocular btm-pt scierez is

Osteoarthritis marginal osteophytes loss of jemt space

Osteoarthritis marginal osteophytes loss of jemt space

Fig. 31.3 X-rays for common arthritic conditions: typical changes

The various immunological tests for diagnosis of the connective tissue disorders are outlined with the description of each condition. Such screening tests include:

• rheumatoid factor

• antinuclear antibodies

• double stranded DNA antibodies

The LE cell test has been superseded by the antinuclear and ds DNA antibody tests.

Arthritis in children

Arthralgia (joint pain) is a common problem in childhood and, although arthritis is rare, the complaint demands considerable respect because of the many serious problems causing it. Arthritis may be part of an infectious disease such as rheumatic fever, rubella, mumps, cytomegalovirus infection, erythema infectiosum (human parvovirus), influenza or other viral infection, and is occasionally encountered with Henoch-Schonlein purpura. It is worth noting that underlying bone tumours can be present as joint pain if the tumour is adjacent to the joint. A checklist of causes is presented in Table 31.4 .

Note: Acute-onset monoarticular arthritis associated with fever is septic until proven otherwise.

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