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2006, Number 4

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Rev Med Inst Mex Seguro Soc 2006; 44 (4)

Presentation of a Clinical Case of Systemic Juvenile Rheumatoid Arthritis

Guraieb-Ibarrola R, Guraieb-Chahín P

Language: Spanish
References: 38
Page: 355-364
PDF size: 183.53 Kb.


ABSTRACT

A case of a 6-year-old male child was studied. Initially, he presented large-joint arthritis of the right knee and heel, with clinical data of systemic inflammation, such as fever, increase in sedimentation rate and leucocytosis, during more than six weeks of evolution. A wrong initial diagnosis of septic arthritis was made, but the lack of response to antibiotics and surgical drainage of the knee led to a trial with prednisone, which induced clinical remission. The patient remained hospitalized for 24 days and underwent surgical drainage, knee arthroscopy, two bone gammagrams, nuclear magnetic resonance, and antibiotics, as well as considerable stress and uncertainty for him and his family. Thus, it is very important to make an early diagnosis of juvenile rheumatoid arthritis and avoid complications. Recent literature was examined with special emphasis on opportune clinical diagnosis, as well as on therapeutic innovations, which have been able to modify the course of the disease and improve the quality of life of these patients. Pediatricians and general practitioners should take into account this diagnosis when seeing a patient with arthritis, especially when the signs point towards a systemic disease affecting two or more joints.


REFERENCES

  1. Brewer JE. Pitfalls in the diagnosis of juvenile rheumatoid arthritis. Pediatr Clin North Am 1986; 33(5):1015-1032.

  2. Koopman WJ. Arthritis and allied conditions: a textbook of rheumatology. 14th edition. Vol.1 Philadelphia: Lippincott Williams and Wilkins; 2001. p. 1153-1174.

  3. 3. Manners PJ. Delay in diagnosing juvenile arthritis. Med J Aust 1999;171-7:367-369.

  4. 4. Behrman ER, Kliegman RM, Jenson HB. Nelson textbook of pediatrics. 16th edition. WB Saunders; 2000. CD ROM edition. Cap. 156.

  5. 5. Petty R, et al. ILAR Classification of juvenile idiopathic artritis (second revision, Edmonton, 2001). J Rheumatol 2004;31:2 :390-392.

  6. 6. Chantler JK, Tingle AJ, Petty RE. Persistent rubella virus infection associated with chronic arthritis in children. N Engl J Med 1985;333(18):1117-1123.

  7. 7. Young NS. Parvovirus B19. N Engl J Med 2004; 350(5):586-597.

  8. 8. Kishore J, Misra R, Gupta D. Raised IgM antibodies to parvovirus B19 in juvenile rheumatoid arthritis. Indian J Med Res 1998;107:15-18.

  9. 9. Landenberg P, Lehmann HW, Knoll A, Dorsch S, Modrow S. Antiphospholipid antibodies in pediatric and adult patients with rheumatic disease are associated with Parvovirus B19 infection. Arthritis Rheum 2003;48:1393-1347.

  10. Choy HS, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 2001;344(12):907-914.

  11. Woolley DE. The mast cell in inflammatory arthritis. N Engl J Med 2003;348(17):1709-1711.

  12. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med 2004;350(21):2167-2177.

  13. Hollister JR. Juvenile rheumatoid arthritis. En: Hay WW, Hayward AR, Levin MJ, Sondheiner JM, editors. Current pediatric diagnosis and treatment. 16th edition. USA: McGraw Hill; 2003. p. 828-835.

  14. Schneider R, Passo MH. Juvenile rheumatoid arthritis. Rheum Dis Clin North Am 2002;28:503-530.

  15. O’Dell JR. Therapeutic strategies for rheumatoid arthritis. N Engl J Med 2004;350(25):2591-2602.

  16. Edwards JCW, Szczepanski L, Szechinski J. Efficacy of B cell targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med 2004;350: 2572-2581.

  17. Ilowite NT. Current treatment of juvenile rheumatoid arthritis. Pediatrics 2002;109:109-115.

  18. Lovell DJ, Gianini EH, Reiff A, et al. Etarnecept in children with polyarticular juvenile rheumatoid arthritis. N Engl J Med 2000;342:763-769.

  19. Mayor S. Combination therapy reduces symptoms and joint erosion in rheumatoid arthritis. Br Med J 2004;328:544.

  20. Brewer JE. Pitfalls in the diagnosis of juvenile rheumatoid arthritis. Pediatr Clin North Am 1986; 33(5):1015-1032.

  21. Koopman WJ. Arthritis and allied conditions: a textbook of rheumatology. 14th edition. Vol.1 Philadelphia: Lippincott Williams and Wilkins; 2001. p. 1153-1174.

  22. 3. Manners PJ. Delay in diagnosing juvenile arthritis. Med J Aust 1999;171-7:367-369.

  23. 4. Behrman ER, Kliegman RM, Jenson HB. Nelson textbook of pediatrics. 16th edition. WB Saunders; 2000. CD ROM edition. Cap. 156.

  24. 5. Petty R, et al. ILAR Classification of juvenile idiopathic artritis (second revision, Edmonton, 2001). J Rheumatol 2004;31:2 :390-392.

  25. 6. Chantler JK, Tingle AJ, Petty RE. Persistent rubella virus infection associated with chronic arthritis in children. N Engl J Med 1985;333(18):1117-1123.

  26. 7. Young NS. Parvovirus B19. N Engl J Med 2004; 350(5):586-597.

  27. 8. Kishore J, Misra R, Gupta D. Raised IgM antibodies to parvovirus B19 in juvenile rheumatoid arthritis. Indian J Med Res 1998;107:15-18.

  28. 9. Landenberg P, Lehmann HW, Knoll A, Dorsch S, Modrow S. Antiphospholipid antibodies in pediatric and adult patients with rheumatic disease are associated with Parvovirus B19 infection. Arthritis Rheum 2003;48:1393-1347.

  29. Choy HS, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 2001;344(12):907-914.

  30. Woolley DE. The mast cell in inflammatory arthritis. N Engl J Med 2003;348(17):1709-1711.

  31. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med 2004;350(21):2167-2177.

  32. Hollister JR. Juvenile rheumatoid arthritis. En: Hay WW, Hayward AR, Levin MJ, Sondheiner JM, editors. Current pediatric diagnosis and treatment. 16th edition. USA: McGraw Hill; 2003. p. 828-835.

  33. Schneider R, Passo MH. Juvenile rheumatoid arthritis. Rheum Dis Clin North Am 2002;28:503-530.

  34. O’Dell JR. Therapeutic strategies for rheumatoid arthritis. N Engl J Med 2004;350(25):2591-2602.

  35. Edwards JCW, Szczepanski L, Szechinski J. Efficacy of B cell targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med 2004;350: 2572-2581.

  36. Ilowite NT. Current treatment of juvenile rheumatoid arthritis. Pediatrics 2002;109:109-115.

  37. Lovell DJ, Gianini EH, Reiff A, et al. Etarnecept in children with polyarticular juvenile rheumatoid arthritis. N Engl J Med 2000;342:763-769.

  38. Mayor S. Combination therapy reduces symptoms and joint erosion in rheumatoid arthritis. Br Med J 2004;328:544.




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