© 2004 by BMJ Publishing Group Ltd & European League Against Rheumatism
LESSON OF THE MONTH
Systemic juvenile idiopathic arthritis presenting in a young child with long term disability as an adolescent
Series editor: Anthony D Woolf
1 Department of Rheumatology, Birmingham Children’s Hospital, Birmingham, UK
2 Institute of Child Health, Birmingham Children’s Hospital, Birmingham, UK
3 Hopital Des Enfants Malades, Paris, France
Correspondence to:
Correspondence to:
Dr J E McDonagh
Institute of Child Health, Birmingham Children’s Hospital and University of Birmingham, Steelhouse Lane, Birmingham B4 6NH, UK; j.e.mcdonagh@bham.ac.uk
Abbreviations: CRP, C reactive protein; ESR, erythrocyte sedimentation rate; GH, growth hormone; JIA, juvenile idiopathic arthritis; IL, interleukin; SJIA, systemic juvenile idiopathic arthritis
Keywords: adolescence; juvenile idiopathic arthritis; transition
| The first 150 words of the full text of this article appear below. |
A young man now aged 19 years presented, aged 2
years, with an 8 week history of being unwell with high swinging fevers, a "measles"-type rash, anorexia, and weight loss. He complained throughout this time of a painful right knee, and subsequently, pain in his left wrist and ankle, neck, and elbows. Initial assessment confirmed synovitis in his left ankle, right hip, neck, and some small joints of his hands. He had a quotidian fever pattern, intermittent macular rash, lymphadenopathy but no splenomegaly, and a cardiovascular examination was normal. Inflammatory markers were high (erythrocyte sedimentation rate (ESR) 129 mm/1st h; C reactive protein (CRP) 226 mg/l; platelets 594x109/l—peak 1360x109/l), haemoglobin 92 g/l; white blood cell count 9.6x109/l (neutrophils 6.6, lymphocytes 1.9), and albumin 24 g/l. The differential diagnosis included systemic arthritis, infections, inflammatory bowel disease, and malignancy.
After exclusion of these
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