Patient Case: Juvenile Idiopathic Arthritis
A 9-year-old child is brought to a community health clinic by their parents due to persistent joint swelling and stiffness, particularly in the knees and wrists, for the past four months. The parents report that the child has difficulty getting out of bed in the morning due to stiffness, which improves slightly after some movement. The child has also been more fatigued than usual and has had occasional low-grade fevers.
Medical History & Social Background
The child has no history of previous joint injuries or infections. There is no known family history of autoimmune diseases. The parents initially attributed the symptoms to normal childhood growth pains but became concerned as the swelling persisted. The child attends school but has been struggling to participate in physical activities due to joint pain.
Physical Examination
• Swelling and tenderness in both knees and wrists, with limited range of motion.
• Mild warmth over affected joints but no significant redness.
• No skin rashes, nodules, or other systemic findings.
• No evidence of recent infections or trauma.
Laboratory & Imaging Findings
• Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
• Rheumatoid factor (RF): Negative.
• Anti-nuclear antibodies (ANA): Positive.
• X-ray: Shows periarticular osteopenia but no significant joint erosion.
Diagnosis
Based on the clinical presentation and test results, the child is diagnosed with juvenile idiopathic arthritis (JIA), oligoarticular type.
Management Plan
1. Pharmacologic Treatment
• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.
• Methotrexate for disease-modifying treatment in case of worsening symptoms.
• Close monitoring for uveitis due to positive ANA.
Non-Pharmacologic Treatment
• Referral to a physiotherapist for joint exercises to maintain mobility.
• Parental education on the importance of early treatment and follow-ups.
• School modifications to accommodate physical limitations.
Follow-Up & Monitoring
• Regular ophthalmologic screenings for uveitis.
• Blood tests to monitor inflammation and medication side effects.
• Adjustments to therapy based on disease progression.
Challenges & Considerations
• Limited access to pediatric rheumatologists.
• Financial constraints affecting long-term treatment adherence.
• Need for increased awareness among caregivers and school staff.
Prognosis
With early intervention and appropriate management, the child has a good chance of maintaining joint function and avoiding long-term disability. However, regular monitoring is essential to prevent complications such as uveitis and joint contractures.
A) Rheumatoid arthritis
B) Septic arthritis
C) Juvenile idiopathic arthritis (JIA)
D) Systemic lupus erythematosus
A) Positive anti-nuclear antibodies (ANA)
B) Negative rheumatoid factor (RF)
C) Mild periarticular osteopenia on X-ray
D) Low-grade fever
A) Methotrexate
B) Non-steroidal anti-inflammatory drugs (NSAIDs)
C) Prednisolone
D) Hydroxychloroquine
A) Osteoporosis
B) Uveitis
C) Pulmonary fibrosis
D) Kidney failure
