Background/Purpose: Migratory Arthritis, a not uncommon presentation in pediatrics, is classically associated with rheumatic fever (RF), although can be the first presentation of other medical conditions as well. The literature focusing on this phenomenon is sparse. Our aim was to review the cases presented at our institution, describe the range of conditions associated with it, and propose a workup plan for migratory arthritis in children.

Methods: A review of all cases of migratory arthritis in children (aged 0-18 years) presented between 2003-2023 within the emergency department and the pediatric rheumatology clinic. We extracted primary diagnoses along with epidemiological, clinical, and laboratory parameters. Next, we compared cases related to RF with other cases.

Results: A total of 165 cases of migratory arthritis were identified. Among them 67 (40%) were diagnosed with RF, while the others had various conditions, including post-streptococcal reactive arthritis, post-viral arthritis, reactive arthritis, inflammatory bowel disease, systemic lupus erythematosus, and, rarely, malignancy. High population density areas were a significant predictors for RF (P = 0.001), as well as a family history of RF (P = 0.03) and fever (P = 0.002). Conversely, rash was more common in the non-RF group, as well as arthralgia compared to arthritis. 

Conclusion: :  Migratory arthritis is not rare with a mean presentation of at least one case per month. Moreover, only 41% of cases of migratory arthritis were associated with rheumatic fever. A significant proportion of diagnoses belong to post-infectious conditions. Clinically important, malignancies are include in the differential diagnosis. There were only few cases of JIA. Migratory arthritis in children poses a diagnostic challenge, and this study proposes a diagnostic algorithm based on the collected data.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/migratory-arthritis-in-children-what-besides-rheumatic-fever/