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15-09-2016 | Juvenile idiopathic arthritis | Case report | Article

Atypical monoarthritis presentation in children with oligoarticular juvenile idiopathic arthritis: a case series

Journal: Pediatric Rheumatology

Authors: Natasha Lepore, Megan Cashin, Debra Bartley, Daniela Simona Ardelean

Publisher: BioMed Central

Abstract

Background

Oligoarticular juvenile idiopathic arthritis (oligoJIA), the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Severe oligoJIA monoarthritis presenting in a joint other than knees and ankles, is rare.

Findings

We report four children who presented with severe isolated arthritis of the hip, wrist or elbow and were diagnosed with oligoJIA. All four were girls with a median age of 11.5 years. Those with hip arthritis also met the classification criteria for juvenile-onset spondylarthopathy. Median duration of symptoms prior to diagnosis was 9.5 months. Three children had already cartilage loss or erosive disease at diagnosis.

Conclusions

Children diagnosed with oligoJIA that present with monoarthritis of the hip, wrist and elbow can have aggressive disease. Girls with positive HLA-B27 presenting with isolated hip arthritis could meet the classification criteria for both oligoJIA and juvenile-onset SpA. Early referral to specialized care may improve their diagnosis, treatment and outcome.
Literature
1.
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P, International League of Associations for R. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2.PubMed
2.
Shiff NJ, Lix LM, Oen K, Joseph L, Duffy C, Stringer E, Tucker LB, Svenson LW, Belisle P, Bernatsky S. Chronic inflammatory arthritis prevalence estimates for children and adolescents in three Canadian provinces. Rheumatol Int. 2015;35(2):345–50. doi:10.​1007/​s00296-014-3085-0.CrossRefPubMed
3.
Oen KG, Cheang M. Epidemiology of chronic arthritis in childhood. Semin Arthritis Rheum. 1996;26(3):575–91.CrossRefPubMed
4.
Ravelli A, Martini A. Early predictors of outcome in juvenile idiopathic arthritis. Clin Exp Rheumatol. 2003;21(5 Suppl 31):S89–93.PubMed
5.
Al-Matar MJ, Petty RE, Tucker LB, Malleson PN, Schroeder ML, Cabral DA. The early pattern of joint involvement predicts disease progression in children with oligoarticular (pauciarticular) juvenile rheumatoid arthritis. Arthritis Rheum. 2002;46(10):2708–15. doi:10.​1002/​art.​10544.CrossRefPubMed
6.
Cassone R, Falcone A, Rossi F, Magni-Manzoni S, Felici E, Buoncompagni A, Martini A, Ravelli A. Unilateral destructive wrist synovitis in juvenile idiopathic arthritis. Clin Exp Rheumatol. 2004;22(5):637–42.PubMed
7.
Chedeville GAM, Scuccimarri R. A104:aggresive erosive synovitis in juvenile idiopathic arthritis. Arthritis Rheum. 2014;66(S3):S140.CrossRef
8.
Marino A, Pagnini I, Savelli S, Moretti D, Simonini G, Cimaz R. Elbow monoarthritis: an atypical onset of juvenile idiopathic arthritis. Reumatismo. 2012;64(3):175–9. doi:10.​4081/​reumatismo.​2012.​175.CrossRefPubMed
9.
Hemke R, Nusman CM, van der Heijde DM, Doria AS, Kuijpers TW, Maas M, van Rossum MA. Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: implications for MR imaging as outcome measure. Rheumatol Int. 2015;35(2):351–7. doi:10.​1007/​s00296-014-3108-x.CrossRefPubMed
10.
Zuber Z, Turowska-Heydel D, Sobczyk M, Chudek J. Prevalence of HLA-B27 antigen in patients with juvenile idiopathic arthritis. Reumatologia. 2015;53(3):125–30. doi:10.​5114/​reum.​2015.​53133.CrossRefPubMedPubMedCentral
11.
Amor B, Dougados M, Mijiyawa M. Criteria of the classification of spondylarthropathies. Rev Rhum Mal Osteoartic. 1990;57(2):85–9.PubMed
12.
Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, Van den Bosch F, Olivieri I, Roussou E, Scarpato S, Sorensen IJ, Valle-Onate R, Weber U, Wei J, Sieper J. The assessment of SpondyloArthritis international society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25–31. doi:10.​1136/​ard.​2010.​133645.CrossRefPubMed
13.
Nam JL, Hensor EM, Hunt L, Conaghan PG, Wakefield RJ, Emery P. Ultrasound findings predict progression to inflammatory arthritis in anti-CCP antibody-positive patients without clinical synovitis. Ann Rheum Dis. 2016;75(12):2060–7. doi:10.​1136/​annrheumdis-2015-208235.CrossRefPubMed