A young boy 12 years of age has swelling and pain involving more than one large joints of the body along with fever and a history of sore throat. Which of the following conditions you will consider as the first possibility?

A. Rheumatoid arthritis
B. Septic arthritis
C. Osteoarthritis
D. Rheumatic fever
E. Tuberculosis arthritis

Answer:

D. Rheumatic fever

Explanation:

In a 12-year-old boy presenting with swelling and pain in multiple large joints, along with fever and a history of a sore throat, the first possibility to consider is rheumatic fever.

Here’s the reasoning:

• Age: Rheumatic fever commonly affects children and adolescents, and the patient’s age of 12 years is consistent with this condition.
• Joint Involvement: The characteristic feature of rheumatic fever is migratory polyarthritis, which involves multiple large joints and tends to shift from one joint to another. This joint pain and swelling can be accompanied by fever.
• History of Sore Throat: Rheumatic fever often follows an untreated or inadequately treated streptococcal pharyngitis (sore throat). The history of a sore throat in this case is significant because it suggests a possible connection to the rheumatic fever.

Let’s briefly discuss the other options:

1. Rheumatoid arthritis: Rheumatoid arthritis typically affects adults and presents with symmetrical joint involvement, which is different from the migratory pattern seen in rheumatic fever.
2. Septic arthritis: While septic arthritis can cause joint pain and swelling with fever, it’s more commonly associated with a single joint, and the patient’s age and history of a sore throat make this diagnosis less likely.
3. Osteoarthritis: Osteoarthritis is generally a condition of older individuals and is characterized by degenerative changes in joints. It does not typically cause systemic symptoms like fever.
4. Tuberculosis arthritis: Tuberculosis arthritis is less common than other forms of tuberculosis and usually presents with a more indolent course. It’s less likely in a young patient with acute joint involvement and fever.