Relapses of systemic juvenile rheumatoid arthritis associated with intravascular coagulation are rare. This paper describes a patient who, over a two year period, had two relapses, each accompanied by evidence of liver and renal damage and disseminated intravascular coagulation. The patient was not receiving non-steroidal anti-inflammatory drugs, and all laboratory and clinical manifestations of her disease rapidly resolved after treatment with prednisone. It is therefore believed that the hepatocellular damage, in addition to the disseminated intravascular coagulation, was a direct manifestation of disease activity. A possible pathogenic role for tumour necrosis factor is suggested.
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