Approach to a child with monoarthritis.

Abstract Arthritis in childhood is common. The pattern, presentation and duration of arthritis help differentiate between the various possible diagnoses. When only one joint is involved, i.e., monoarthritis, it may be difficult to make a diagnosis as there are many possibilities both acute and chronic in nature. A detailed history and clinical examination is important to reach a correct diagnosis and the single most important investigation when a child presents acutely is a joint aspiration to rule out septic arthritis that may destroy the joint in hours. Inflammatory markers, antinuclear antibody testing, test for tuberculosis and imaging (in specific cases) play an important role in the diagnosis of a child that presents with a chronic monoarthritis. In this article we provide a clinical approach to the diagnosis of monoarthritis in a child.

Determinants of lead level in umbilical cord blood.

Lead levels were measured by atomic absorption spectrophotometry in umbilical cord blood samples of 205 consecutively born neonates and venous blood in 62 of the mothers. The mean (± SD) cord blood lead level was 4.7 ± 12.1 µg/dL. In the sub sample of 62 mother-baby pairs, the mean (± SD) cord blood lead levels were 1.6 ± 2.5 µg/dL and 2.0 ± 2.1 µg/dL, respectively. According to CDC risk categories, 92% babies were in Class I of which 87% had lead levels below 5 µg/dL. The mean (± SD) birthweight in <5 µg/dL category was 2640 ± 445 grams as compared to 2617 ± 408 grams in >5 µg/dL category. The mean (± SD) gestational ages were 39.1 ± 2.0 weeks and 38.1±2.0 weeks, respectively in the two groups (P=0.014). On multivariate linear analysis, lower gestational age significantly correlated with higher cord blood lead level.