Masterclass
Bridging the gap in rheumatology
Janet E McDonagh, Taunton R Southwood, Clive A J Ryder
Department of
Rheumatology, Birmingham Children's Hospital NHS Trust, Birmingham
Correspondence to: Dr J E McDonagh, Department of Rheumatology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH
Accepted for publication 6 September 1999
| The first 150 words of the full text of this article appear below. |
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Case history |
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PRESENTATION AND MANAGEMENT
Louise is now 18 years old. She is white and developed erosive,
polyarticular psoriatic arthritis with significant skin involvement when she was 10 years old . She was referred to the paediatric rheumatology team at the age of 13 having previously been treated with
non-steroidal anti-inflammatory drugs, sulfasalazine and intra-articular corticosteroids. She was subsequently treated with
further multiple intra-articular corticosteroid injections under
general anaesthetic, oral methotrexate (maximum 20 mg/week) and
naproxen (20 mg/kg/day).
| Table Removed (Available Only in the Full Text) |
Her disease failed to remit and oral methotrexate was replaced with
weekly subcutaneous methotrexate (maximum 25 mg/week, given by
Louise's mother) and continuous oral daily prednisolone (0.5 mg/kg/day). After three months of subcutaneous methotrexate treatment,
Louise developed persistently abnormal liver function tests (maximum
alanine transaminase (ALT) =286 IU/l, alkaline phosphatase (ALP) =718
IU/l). Methotrexate was subsequently omitted and re-introduced at a
lower dose but to the detriment of the arthritis, which flared
requiring increased prednisolone treatment. In view of the desire to
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