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Migratory arthritis in children - A clinical clue to diverse diagnoses.

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Titel:	Migratory arthritis in children - A clinical clue to diverse diagnoses.
Autoren:	Goldberg B; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Amarilyo G; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel., Scheuerman O; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Harel L; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel., Zuabi T; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Guz A; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Ravia M; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Goldberg L; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Shkalim Zemer V; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Clalit Health Services, Petah Tikva, Israel., Levinsky Y; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. yoel.levinsky@clalit.org.il.; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yoel.levinsky@clalit.org.il.; Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel. yoel.levinsky@clalit.org.il.
Quelle:	European journal of pediatrics [Eur J Pediatr] 2025 Nov 14; Vol. 184 (12), pp. 756. Date of Electronic Publication: 2025 Nov 14.
Publikationsart:	Journal Article
Sprache:	English
Info zur Zeitschrift:	Publisher: Springer Verlag Country of Publication: Germany NLM ID: 7603873 Publication Model: Electronic Cited Medium: Internet ISSN: 1432-1076 (Electronic) Linking ISSN: 03406199 NLM ISO Abbreviation: Eur J Pediatr Subsets: MEDLINE
Imprint Name(s):	Publication: Berlin : Springer Verlag Original Publication: Berlin, New York, Springer-Verlag.
MeSH-Schlagworte:	Rheumatic Fever/diagnosis , Rheumatic Fever/complications , Arthritis/diagnosis , Arthritis/etiology, Humans ; Child ; Child, Preschool ; Male ; Diagnosis, Differential ; Female ; Adolescent ; Infant ; Retrospective Studies ; Arthritis, Reactive/diagnosis ; Infant, Newborn
Abstract:	Competing Interests: Declarations. Ethics approval: The study was approved by the Research Ethics Board of Rabin Medical Center (Approval No. RMC 0339–22)) in accordance with the Declaration of Helsinki. Conflict of interest: The authors declare no competing interests. Migratory arthritis is classically associated with acute rheumatic fever (ARF), but may signify other medical conditions. We aimed to track the final diagnoses of this obscure presentation, and to distinguish clinical variables that differentiate ARF from other conditions in order to facilitate the clinical diagnosis of ARF. Medical records were reviewed of all the patients aged 0-18 years who presented with migratory arthritis during 2015-2023 at the emergency department, pediatric wards, and the rheumatology unit of a large tertiary medical center. Primary diagnoses, demographic, clinical, and laboratory parameters were extracted and compared between patients with ARF and those with other diagnoses. A total of 101 patients with migratory arthritis were identified. Of them, 50 (49.5%) were diagnosed with ARF. The others had various conditions, including reactive arthritis (9.9%), post-streptococcal reactive arthritis (7.9%), post-viral arthritis (5%), inflammatory bowel disease (4%), systemic lupus erythematosus (3%), and malignancy (2%). Factors associated with an ARF diagnosis compared to other diagnoses were: residence in areas of highly crowded households (P = 0.007), and elevated CRP (P = 0.002). Abnormal medical background, rash, and a positive antinuclear antibody test were associated with other diagnoses. Conclusions: The differential diagnosis of pediatric migratory arthritis is diverse. Merely half of the patients were diagnosed with ARF. A considerable proportion of diagnoses related to post-infectious conditions. Malignancies, though rare, are an important differential. Only a small proportion had juvenile idiopathic arthritis. Migratory arthritis poses a diagnostic challenge and ARF should be differentiated from other diagnoses where applicable. What Is Known: • Migratory arthritis is classically associated with acute rheumatic fever (ARF), but may signify other medical conditions. • The literature focusing on migratory arthritis is sparse. What Is New: • The differential diagnosis of pediatric migratory arthritis is diverse. • Merely half of patients were diagnosed with acute rheumatic fever. (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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(PMID: 10.1136/archdischild-2014-30775126216831) Vinker S, Zohar E, Hoffman R, Elhayany A (2010) Incidence and clinical manifestations of rheumatic fever: a 6 year community-based survey. Isr Med Assoc J 12(2):78–81. (PMID: 20550029) Tal R, Hamad Saied M, Zidani R, Levinsky Y, Straussberg R, Amir J et al (2022) Rheumatic fever in a developed country - is it still relevant? A retrospective, 25 years follow-up. Pediatr Rheumatol Online J 20(1):20. https://doi.org/10.1186/s12969-022-00678-7. (PMID: 10.1186/s12969-022-00678-7352920668922867) Alpay-Kanıtez N, Çelik S, Bes C (2018Oct 1) Polyarthritis and its differential diagnosis. Eur J Rheumatol 6(4):167–173. https://doi.org/10.5152/eurjrheum.2019.19145. (PMID: 10.5152/eurjrheum.2019.19145316576986812894) Maness DL, Martin M, Mitchell G (2018Apr 15) Poststreptococcal illness: recognition and management. Am Fam Physician 97(8):517–522. (PMID: 29671499) Marks M, Marks JL (2016) Viral arthritis. Clin Med 16(2):129–134. https://doi.org/10.7861/clinmedicine.16-2-129. (PMID: 10.7861/clinmedicine.16-2-129) Braun J, Kingsley G, van der Heijde D, Sieper J (2000 Sep) On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3–6, 1999. J Rheumatol 27(9):2185–92. Israel Central bureau of statistics: Households, economic characteristics, and housing density. 2023. https://www.cbs.gov.il/he/publications/DocLib/2023/1891/h_print.pdf. WHO Housing and Health Guidelines. Geneva: World Health Organization; 2018. 3, Household crowding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535289/. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R et al (2019) 2019 European league against Rheumatism/American college of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis 78(9):1151–1159. https://doi.org/10.1136/annrheumdis-2018-214819. (PMID: 10.1136/annrheumdis-2018-21481931383717) Qu F, Guilak F, Mauck RL (2019) Cell migration: implications for repair and regeneration in joint disease. Nat Rev Rheumatol 15(3):167–179. https://doi.org/10.1038/s41584-018-0151-0. (PMID: 10.1038/s41584-018-0151-0306172657004411) Guilherme L, Kalil J (2010) Rheumatic fever and rheumatic heart disease: cellular mechanisms leading autoimmune reactivity and disease. J Clin Immunol 30(1):17–23. https://doi.org/10.1007/s10875-009-9332-6. (PMID: 10.1007/s10875-009-9332-619802690) Nakamachi Y, Uto K, Hayashi S, Okano T, Morinobu A, Kuroda R, Kawano S, Saegusa J (2023) Exosomes derived from synovial fibroblasts from patients with rheumatoid arthritis promote macrophage migration that can be suppressed by miR-124-3p. Heliyon 9(4):e14986. https://doi.org/10.1016/j.heliyon.2023.e14986. (PMID: 10.1016/j.heliyon.2023.e149863715168710161379) Chen Z, Wang H, Xia Y, Yan F, Lu Y (2018) Therapeutic potential of mesenchymal cell-derived miRNA-150-5p-expressing exosomes in rheumatoid arthritis mediated by the modulation of MMP14 and VEGF. J Immunol 201(8):2472–2482. https://doi.org/10.4049/jimmunol.1800304. (PMID: 10.4049/jimmunol.1800304302245126176104) Pastore S, De Cunto A, Benettoni A, Berton E, Taddio A, Lepore L (2011) The resurgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatology (Oxford) 50(2):396–400. https://doi.org/10.1093/rheumatology/keq290. (PMID: 10.1093/rheumatology/keq29021047802) Engel ME, Stander R, Vogel J, Adeyemo AA, Mayosi BM (2011) Genetic susceptibility to acute rheumatic fever: a systematic review and meta-analysis of twin studies. PLoS One 6(9):e25326. https://doi.org/10.1371/journal.pone.0025326. (PMID: 10.1371/journal.pone.0025326219804283184125) Shankar B, Bhutia E, Kumar D (2016) Atypical arthritis revisited: acute rheumatic fever. Ann Pediatr Cardiol 9(2):164–166. https://doi.org/10.4103/0974-2069.180670. (PMID: 10.4103/0974-2069.180670272128534867803) Karthikeyan G, Guilherme L (2018) Acute rheumatic fever. Lancet 392(10142):161–174. https://doi.org/10.1016/S0140-6736(18)30999-1. (PMID: 10.1016/S0140-6736(18)30999-130025809)
Contributed Indexing:	Keywords: Emergency department; Migratory arthritis; Pediatrics; Rheumatology
Entry Date(s):	Date Created: 20251114 Date Completed: 20251115 Latest Revision: 20251114
Update Code:	20251115
DOI:	10.1007/s00431-025-06607-6
PMID:	41238996
Datenbank:	MEDLINE

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Abstract:	Competing Interests: Declarations. Ethics approval: The study was approved by the Research Ethics Board of Rabin Medical Center (Approval No. RMC 0339–22)) in accordance with the Declaration of Helsinki. Conflict of interest: The authors declare no competing interests.<br />Migratory arthritis is classically associated with acute rheumatic fever (ARF), but may signify other medical conditions. We aimed to track the final diagnoses of this obscure presentation, and to distinguish clinical variables that differentiate ARF from other conditions in order to facilitate the clinical diagnosis of ARF. Medical records were reviewed of all the patients aged 0-18 years who presented with migratory arthritis during 2015-2023 at the emergency department, pediatric wards, and the rheumatology unit of a large tertiary medical center. Primary diagnoses, demographic, clinical, and laboratory parameters were extracted and compared between patients with ARF and those with other diagnoses. A total of 101 patients with migratory arthritis were identified. Of them, 50 (49.5%) were diagnosed with ARF. The others had various conditions, including reactive arthritis (9.9%), post-streptococcal reactive arthritis (7.9%), post-viral arthritis (5%), inflammatory bowel disease (4%), systemic lupus erythematosus (3%), and malignancy (2%). Factors associated with an ARF diagnosis compared to other diagnoses were: residence in areas of highly crowded households (P = 0.007), and elevated CRP (P = 0.002). Abnormal medical background, rash, and a positive antinuclear antibody test were associated with other diagnoses.<br />Conclusions: The differential diagnosis of pediatric migratory arthritis is diverse. Merely half of the patients were diagnosed with ARF. A considerable proportion of diagnoses related to post-infectious conditions. Malignancies, though rare, are an important differential. Only a small proportion had juvenile idiopathic arthritis. Migratory arthritis poses a diagnostic challenge and ARF should be differentiated from other diagnoses where applicable.<br />What Is Known: • Migratory arthritis is classically associated with acute rheumatic fever (ARF), but may signify other medical conditions. • The literature focusing on migratory arthritis is sparse.<br />What Is New: • The differential diagnosis of pediatric migratory arthritis is diverse. • Merely half of patients were diagnosed with acute rheumatic fever.<br /> (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
ISSN:	1432-1076
DOI:	10.1007/s00431-025-06607-6