Methotrexate continues to be the safest and most efficacious second-line drug for the treatment of JRA. In addition, it is useful in other inflammatory conditions in children. Careful education is necessary, particularly with regard to the importance of laboratory tests and the avoidance of comorbidity such as pregnancy and alcohol-induced liver injury. Health care providers should be comfortable discussing these issues with children and adolescents.
Although a diagnosis of gout can be confirmed by the presence of monosodium urate crystals in synovial fluid, arriving at the suspected diagnosis and managing the disease can be a challenge for primary care physicians and specialists alike. Symptoms of gout can mimic other forms of inflammatory arthritis such as rheumatoid arthritis, pseudogout, or septic arthritis. Treatment can be complicated by the patient's need for drugs that contribute to hyperuricemia. Once other diagnoses are ruled out and urate crystals are detected under polarized light microscopy, treatment to end the acute attack and follow-up treatment designed to lower serum urate levels can be undertaken.
Infections caused by human parvovirus B19 result in a variety of clinical manifestations, the severity of which depends on the immune and hematologic status of the host. Arthropathy is known to occur in children and adults with acute parvovirus B19 infection. In adults, the arthropathy is common and is usually brief and self-limited, although a chronic arthropathy due to HPV B19 infections can occur rarely. It is important to differentiate between such chronic infection and RA, because of the similar clinical manifestations and different modes of treatment. An association between HPV B19 and other rheumatologic diseases such as vasculitis needs further research before confirmation is possible.
In most cases, a thorough initial evaluation will reveal the cause of fever and polyarthritis. However, in some patients the initial diagnosis may be unclear and, as time passes, the characteristic clinical patterns emerge. Recurrent attacks are suggestive of other conditions such as crystal-induced arthritis, Lyme disease, and Mediterranean fever. In rheumatoid arthritis and Reiter's syndrome, the fever resolves and the articular findings predominate with the passage of time. Similarly, Still's disease is initially diagnosed on the basis of clinical criteria, and later confirmed by the evolution of chronic polyarthritis. Diagnostic approaches for the evaluation of patients presenting with acute arthritis have been published and are readily available (2,8,9). The most reliable way to establish the diagnosis for a rheumatic disease is thoughtful and thorough evaluation by an experienced clinician (3,10). Certain discriminating features and confirmatory tests can aid in the diagnosis of polyarthritis with fever (Tables 2 and 3).
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：