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Multiple swollen joints

Multiple swollen joints are unlikely to be due to infection (other than some forms of reactive arthritis) or trauma and makes a systemic disease more likely.

Key conditions include

  • Juvenile Idiopathic Arthritis is likely but malignancy (leukaemia) has to be excluded. 
  • Metabolic conditions (osteomalacia / rickets) 
  • Chromosomal conditions (eg Down syndrome associated arthritis) 
  • Inherited metabolic conditions (eg Mucopolysaccharidoses)
  • Multisystem disease such as Juvenile Systemic Lupus Erythematosus or Juvenile Dermatomyositis or Vasculitis tend to cause joint pain (arthralgia) rather than joint swelling. 
  • Rheumatic fever (a form of reactive arthritis that follows pharyngeal streptococcal infection) is uncommon in the UK, but common in developing countries. The arthritis can involve many joints, often flitting from joint to joint. 
  • Post viral arthritis such as with rubella infection or parvo virus can involve many joints whereas after chicken pox (varicella) can be an oligo-arthritis or polyarthritis.
  • Skeletal dysplasia: can be suspected with short stature, joint contractures and pain often with a positive family history. There may be dysmorphic features. 
  • Poncet's disease : A form of reactive arthritis as a hypersensitivity response to Tuberculosis. Often presents with fever, weight loss and symmetrical polyarthritis.

The photograph below shows polyarthritis affecting small joints of the hands and wrists (Juvenile Idiopathic Arthritis)

The photograph below shows swollen knees and quadriceps wasting due to chronic inflammatory arthritis 

The photograph shows symmetrical bony swelling and deformity in skeletal dysplasia that can mimic JIA

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