Fever and joint pain can be dealt according to their cause which has been discussed here Fever with joint pain. Diagnosis depends on proper history of the patient which includes signs and symptoms, clinical examination and required investigations.
Clinical history of patient with fever and joint pain
A proper history regarding the onset and duration of the disease, number of joints involved, temporal pattern of joint involvement, symmetry of joint involvement, degree of disability, associated systemic symptoms apart from fever, past history of joint pain or any chronic illness etc is taken.
Fever with joint pain may be acute ie present for last few days only or chronic. Joint pain may be monoarticular involving one joint, oligoarticular involving 2-4 joints or polyarticular involving 5 or more joints.
Bacterial infection of the joint commonly produces acute and mono or oligoarticular arthritis. Tuberculosis and some fungal infections produce chronic monoarticular arthritis.
With a migratory pattern of joint involvement, inflammation persists only for few days in each joint for example in acute rheumatic fever or disseminated gonnococcal infections. With an additive or simultaneous pattern, inflammation persists in involved joints as new ones become affected as in reactive arthritis. With an intermittent pattern, episodic involvement occurs, with intervening periods free of joint symptoms for example Gout and Lyme arthritis.
Joint pain with fever may be symmetric as seen in rheumatoid arthritis and SLE or may be asymmetric as seen in septic arthritis, reactive arthritis or Lyme arthritis.
Important associated history of systemic symptoms like conjunctivitis, urethritis and diarrhea may be present in reactive arthritis, rash and photosensitivity may be present in SLE and tophi may be seen in gout. These associated symptoms may help to find out the cause of joint pain.
History of drug intake should always be obtained to determine drug induced joint pain.
Examination of patient with fever and joint pain
During examination we should look for vitals, whether the patient is toxic which may be in bacterial arthritis with sepsis, presence of rash which can be present I viral arthritis, SLE and even rheumatoid arthritis. Lymphadenopathy of sub occipital region may be seen in Rubella infection.
Individual system examination is very essential to determine the cause of joint pain. Musculoskeletal system examination is very essential to determine the cause of joint pain. Musculoskeletal system examination is very much essential to confirm and review the the conclusion from the history taken.
Detailed joint examination is the key to formulate a diagnosis. A patient having fever, sick looking with RED FLAG signs in the joint indicates septic arthritis or gout. Other system examinations also help us to arrive at a diagnosis like presence of a cardiac murmur in acute rheumatic fever and infective endocarditis, ocular findings, skin rashes in SLE, rheumatoid arthritis and reactive arthritis and pulmonary findings in tuberculosis.
Investigations in patients with fever and joint pain
An acute bacterial infection rapidly destroys articular cartilage and damages the joint, all inflamed joints must be evaluated without delay to exclude noninfectious process and determine appropriate antimicrobial therapy. Apart from routine blood examinations, joint aspiration for examination of synovial fluid is very essential to arrive at a diagnosis. Synovial fluid cell ranging 25,000 to 250,000 per uL with more than 90% neutrophils are characteristics of acute bacterial infection of the joint. Gout, rheumatoid and other non inflammatory arthritis are usually associated with less than 50,000 cells per uL. In mycobacterial and fungal infections cell counts are usually less than 30,000 per uL with 50-70% neutrophil and remainder lymphocytes. Definitive diagnosis is based on staining and culture of the synovial fluid.
Raised ESR and CRP (c reactive protein) establish an inflammatory joint disease. Other specific tests, which help to arrive at a specific diagnosis, are
1. Serum rheumatoid factor (RA factor ) and anti CCP (cyclic citrullinated peptide) antibody for rheumatoid arthritis.
2. Antinuclear factor and DsDNA ( double stranded DNA) for SLE.
3. Specific viral antibodies for viral arthritis.
4. In suspected rheumatic fever ASO titre, throat swab, echocardiography and ECG should be done to establish diagnosis.
Arthroscopy and synovial biopsy help to diagnosis of some undiagnosed cases by these measures.
Treatment of patient with fever and joint pain
For all patients of joint pain rest to the joint is very essential. Non-steroidal anti inflammatory drugs are used to reduce joint pain. Antibiotics are given for bacterial infection of the joint, steroid for SLE and rheumatic fever. Intra articular steroid injection is good method of treatment in selected cases of mono and oligoarticular arthritis. Physiotherapy is very essential once the fever and pain subsides.
Early diagnosis and proper treatment is the key to success in preventing joint damage, hence medical consultation is to be done at earliest sign of joint affection with fever.
|Author: fyyazkamal 24 Dec 2009 Member Level: Gold Points : 2|
|Rheumatic Fever |
pain over big joints like knee and ankle joints less often elbow joits
3. movments of affected joint is restricted
1.sweeling of affected joints
2.active movments are reuced and painful
3. signs of inflammation some time persists
test to find out:
1.ASO titre: usually increased
2.C reactive protiens(CRP) increased
3.coombes test: direct & indirect is positive
4. ESR : incresed to many folds
1.rest to the joint by resticting movements
2. infection to be controlled by proper antibiotics perferablly LoNG ACTING PENCILLINS 12 LA 3 weeks for two to three years
3.vitamins supplementation is advised to improve the immunity of the victim
4regular walking and simple exercise to pervent any deformities of the joints