migratory arthritis

Etiology

• disseminated gonococcal infection
• Lyme disease
• acute rheumatic fever
• adult-onset Still's disease

Clinical manifestations

• asymmetric
• generally oligoarthritis

Laboratory

• arthrocentesis & joint fluid culture
• blood culture for disseminated infection a in disseminated gonococcal infection, obtain specimens from cervix, urethra, oropharynx & rectum & test for N gonorrhoeae (see gonorrhea)
  • if N gonorrhoeae confirmed, test for Chlamydia, syphilis, & HIV
  • rule out endocarditis (rheumatic fever)
• serology for Lyme disease
  • IgM appears 4 weeks after exposure
  • IgG appears 6-8 weeks after exposure
  • indicated for early disseminated & late Lyme disease, not indicated for acute (early) localized Lyme disease
• antistreptolysin O (ASO) titer (rheumatic fever)
• erythrocyte sedimentation rate & C-reactive protein are markers of inflammation
• throat culture for Streptococcus (rheumatic fever)

Diagnostic procedures

• EKG (PR prolongation in rheumatic fever)
• echocardiogram (rheumatic fever)

Radiology

• chest X-ray to rule out cardiomegaly (rheumatic fever)

Management

• dependent upon etiology

More general terms

• arthritis