RETROSPECTIVE INVESTIGATION OF ARTHRITIS CASES DETECTED IN CHILDHOOD

Yıl 2025, Cilt: 26 Sayı: 2, 94 - 99, 28.04.2025

Hatice Büyükoflaz , Muhammed Yaşar Kılınç

https://doi.org/10.18229/kocatepetip.1291101

Öz

OBJECTIVE: In this retrospective study, we aimed to evaluate the etiology of arthritis by examining the anamnesis, physical examination and laboratory tests of the patients between 01.01.2012 and 31.12.2014 in Karaman Training and Research Hospital Pediatrics Department.
MATERIAL AND METHODS: The data of 101 patients were retrospectively analyzed. We recorded the results of laboratory investigations, including complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood culture, antinuclear antibody (ANA), antistreptolysin-O (ASO), rheumatoid factor (RF), Familial Mediterranean Fever (FMF) gene mutation, and serological tests including hepatitis viruses, human immunodeficiency virus, Salmonella, Mycoplasma pneumoniae (M. pneumonia), Chickenpox, Epstein-Barr virus, parvovirus, Rubella, Yersinia,Campylobacter, Brucella, and microbiological tests such as culture were analyzed.
RESULTS: The age at initial presentation ranged from 1 to 17 years (mean: 9.74±3.9). In our study, the M/F ratio of 101 patients was 1.4. Diagnostic analysis revealed that 32% of the patients had transient arthritis, 15% had juvenile idiopathic arthritis (JIA), 12% had acute rheumatic fever (ARF), 10% had IgA vasculitis, 8% had reactive arthritis (RA), 6% had Brucella arthritis, 6% had poststreptococcal reactive arthritis (PSRA), 3% had Familial Mediterranean Fever (FMF), 3% had urticarial vasculitis, 2% had arthritis associated with Kawasaki disease, 2% had septic arthritis, and 1% had viral arthritis. In our study, 45.5% of the patients had a recent upper respiratory tract infection history. Leukocytosis was present in 42.4% of patients, elevated CRP in 45.5%, and elevated ESR in 54.8%. Joint involvement was acute (<2 weeks) in 76.3% of patients, subacute (2-6 weeks) in 4.9%, and chronic (>6 weeks) in 18.8%. The most common complaints were knee pain (57.3%) and ankle pain (31.6%). Additional symptoms included fever (36.6%), rash (15.8%), and muscle pain (6.9%). In patients with ARF, RA, and Juvenile Idiopathic Arthritis (JIA), the knee was the most commonly affected joint, while the ankle was most frequently involved in patients with IgA vasculitis and FMF.
CONCLUSIONS: In patients diagnosed with arthritis, the duration of symptoms, migratory or persistent nature of arthritis, the number of affected joints, associated symptoms, family history, physical examination findings, elevated acute-phase reactants, and additional laboratory tests are key factors may be helpful in the differential diagnosis. Although history and physical examination findings are very important in the diagnosis, laboratory findings are also valuable.

Anahtar Kelimeler

Arthritis , Juvenile , Brucellosis , Familial Mediterranean Fever , IgA.

ÇOCUKLUK ÇAĞINDA SAPTANAN ARTRİT VAKALARININ RETROSPEKTİF OLARAK İNCELENMESİ

Öz

AMAÇ: 01.01.2012 ile 31.12.2014 arasında Karaman Eğitim Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları servisinde artrit tanısı alan hastaların dosyalarının retrospektif olarak incelendiği bu çalışmada hastaların anamnez, fizik muayene ve laboratuvar tetkiklerinin incelenerek artrit etyolojilerinin değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM: Toplam 101 hastanın bilgileri retrospektif olarak dosya taraması yöntemi ile incelendi. Tam kan sayımı (CBC), eritrosit sedimantasyon hızı (ESR), C-reaktif protein (CRP), kan kültürü, antinükleer antikor (ANA), antistreptolisin-O (ASO), romatoid faktör (RF), ailevi akdeniz ateşi (FMF) gen mutasyonu ve hepatit virüsleri, insan immün yetmezlik virüsü, Salmonella, Mycoplasma pneumoniae (M. pnömoni), su çiçeği, Epstein-Barr virüsü, Parvovirüs, Kızamıkçık, Yersinia, Kampilobakter, Brusella gibi serolojik degerlendirme sonuçları ve/veya kültür gibi mikrobiyolojik degerlendirme sonuçları incelendi.
BULGULAR: Olguların ilk başvuru yaşları 1-17 yıl (ortalama 9.74±3.9) arasındaydı. Çalışmamızda 101 hastanın E/K oranı 1.4 idi. Olgular tanılara göre incelendiğinde %32’si geçici artrit, %15’i juvenil idiopatik artrit, %12’si akut romatizmal ateş, %10’u Ig A vasküliti, %8’i reaktif artrit, %6’sı Bruselloz artriti, %6’sı poststreptekoksik reaktif artrit, %3’ü ailevi Akdeniz ateşi, %2’si Kawasaki hastalığı artriti, %2’si septik artrit, %1’i viral artrit, %3’ü ürtikeryal vaskülit olarak saptandı. Çalışmamızda hastaların %45.5’inde yakın zamanda geçirilen üst solunum yolu enfeksiyonu hikayesi mevcuttu. Hastaların %42.4’ünde lökositoz, %45.5’inde CRP yüksekliği, %54.8’inde ESR yüksekliği bulunuyordu. Hastaların %76.3’ünde akut, %4.9’inde subakut eklem tutulumu saptanırken, %18.8’unda kronik eklem tutulumu gözlenmiştir. Olguların %65.3’ünde diz tutulumu saptanırken, 2. sıklıkta tutulan eklem ayak bileği idi. Artrit tanısı ile takip edilen hastalar en sık diz ağrısı (%65.3) ve ayak bileği ağrısı (% 31.6) ile başvurmuştur. Hastalarda en sık ateş (%36.6), döküntü (%15.8), kas ağrısı (%6.9) ek şikayeti vardı. Romatizmal ateş, reaktif artrit, juvenil idiopatik artrit, poststreptekoksik reaktif artritte en sık diz tutulumu mevcutken, Ig A vasküliti ve ailevi Akdeniz ateşi’nde en sık ayak bileği tutulumu gözlenmiştir.
SONUÇ: Artrit tanısı alan hastada yakınmanın süresi, gezici ve tekrarlayıcı özelliği, hangi eklemin tutulduğu, ek yakınma, aile öyküsü, muayene bulguları, akut faz reaktanlarının yüksekliği ve diğer ek laboratuvar tetkikleri ayırıcı tanıda yardımcı olabilir. Tanıda öykü, fizik muayene bulguları çok önemli olmakla birlikte, laboratuvar bulguları da değerlidir.

Anahtar Kelimeler

Artrit , Çocuk , Etyoloji , Klinik özellikler

Kaynakça

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