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Tuberculosis may be the cause of arthritis in some children even when they test negative for the infection. The cases of two children are discussed. A four-year-old girl who had lived in Korea developed a swollen knee seven months after returning to the US. While in Korea, she had an unexplained fever and an episode of Bell's palsy. Fluid from the knee was examined but no studies for tuberculosis were done. A chest X-ray was apparently normal. A skin test for tuberculosis was positive though a test nine months earlier had been negative. The child was treated with isoniazid and rifampin and appeared to recover, but follow up was incomplete. An eight-month-old girl developed a tender, swollen knee during an upper respiratory infection accompanied by fever. A bone scan suggested the child had arthritis. Joint fluid and synovial thickening were indicated by an MRI. A skin test for tuberculosis was negative. However, six weeks later the child's brother was diagnosed with tuberculosis. Fluid from the knee tested positive for Mycobacterium tuberculosis infection and the child was treated with isoniazid, rifampin and pyrazinamide.

Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is an uncommon disorder of the lymph glands that is characterized by an increase in the blood levels of proteins called gammaglobulins. Symptoms of AILD include fever, anemia (decreased red blood cell production), abnormal white blood cell production, and the presence of autoantibodies (antibodies that attack the body's own tissues). AILD can affect the liver, spleen, bone marrow and skin. A diagnosis of AILD is usually made by examining samples of lymph node tissue (biopsy). Early in the disease, immune cells (B cells) in the lymph tissue increase in number and make large quantities of antibodies. In some cases this results in the development of malignant (cancerous) lymph node tumors. Most treatments are not effective in treating AILD, and roughly 70 percent of those diagnosed as having AILD die within two years. Most of the patients die as a result of infections. In most cases of AILD the joints are not affected. This article describes the case report of a 61-year-old male patient who developed arthritis several months prior to the onset of AILD. Radiographs (x-rays) of the joints showed signs of swelling, but no cartilage damage or loss. Joint fluid and blood tests for the presence of rheumatoid arthritis were negative. Joint fluid from the wrist contained elevated levels of white blood cells characteristic of AILD. The patient was treated successfully with methylprednisolone and cyclophosphamide. This finding indicates that AILD may affect the joints, and that joint biopsies provide a better method for diagnosing joint involvement than joint fluid sampling. (Consumer Summary produced by Reliance Medical Information, Inc.)

An overview is presented of the types of foreign matter that can cause inflammation within joints together with their diagnosis, how they cause disease, and treatments. Crystals may be deposited within the joint, the most common of which is urate crystals, the cause of gout. Treatment is available to dissolve urate crystals and the crystal deposits that sometimes occur with kidney dialysis but not other types of crystals. Joint inflammation resulting from infection may be difficult to diagnose with without biopsy of the joint membrane and specialized laboratory techniques. The most common entry is via the circulation. Pathogens may cause inflammation by infecting cells, producing toxins, or triggering an immune response. Antibiotics and drainage usually effect cure, although some pathogens are recalcitrant. Artificial joints can introduce foreign bodies through wear. Materials should be used that do not create this problem.