Clinical feature | Potential significance |
Progression of symptoms | The pain of bacterial arthritis does not wax and wane over time |
Joint trauma | May provide a point of entry for direct inoculation, which is associated with unusual pathogens (eg, sporotrichosis, Pasteurella, anaerobes) |
Rash | May help to determine etiology (eg, Neisseria gonorrhoeae, Neisseria meningitidis, Lyme disease) Varicella-zoster virus may cause primary arthritis |
Skin or soft tissue infection | May provide a portal of entry for Staphylococcus aureus or group A streptococcal bacteremia |
Recent use of antibiotics | May attenuate symptoms in bacterial arthritis May be associated with antecedent infection associated with postinfectious arthritis May be associated with serum sickness-like reaction |
Recent or concurrent illness | Upper respiratory tract infection may precede bacterial arthritis or transient synovitis Enteric, genitourinary, and respiratory infections may precede postinfectious reactive arthritis Concurrent varicella-zoster virus infection may provide a portal of entry for S. aureus or group A Streptococcus, leading to bacteremia |
Onset of most recent menses (for postpubertal females) | Disseminated gonococcal infection usually occurs in the first seven days of the menstrual cycle |
Exposure and travel history | May suggest a particular pathogen or other condition (eg, Mycobacteria tuberculosis, Lyme disease, coccidioidomycosis, hepatitis B, histoplasmosis, chikungunya virus) |
History of sickle cell disease | May have vaso-occlusive joint pain and/or may develop bacterial arthritis as a complication |
Immunization status | Arthritis caused by Haemophilus influenzae type b, Streptococcus pneumoniae, hepatitis B virus, measles, and mumps may occur in unimmunized children Receipt of rubella vaccine virus is associated with joint symptoms two weeks after immunization |
Family history of rheumatologic disease or inflammatory bowel disease | May provide an alternative explanation for signs and symptoms |
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