541 The Diagnosis and Treatment Particularities in a Case with Juvenile Idiopathic Arthritis

Abstract

Background and aims: To emphasize the diagnosis peculiarities and treatment difficulties in a case with joint pains. Methods: The authors present a 15 year-old girl admitted for chronic limping. Personal history: morning stiffness and progressive walking difficulties due to arthralgia during last 12 months, progressive regression in motor skills. The girl has followed a chronic therapy with retard penicillines because of persistent high ASLO titer (rheumatic fever suspicion). Clinical exam: impaired nutritional status (- 3 SD), symmetric joint involvement: pain and swelling for proximal interphalangeal hand joints, metacarpophalangeal joints, wrists, knees, ankles and temporomandibular joints, boutonniere deformities and ankylosis for hand fingers, hands and legs muscles atrophy. Results: Laboratory investigations: elevated inflammatory markers, negative rheumatoid factor, positive antinuclear antibodies, high ASLO titer, hypergammaglobulinemia. The imagistic approach: periarticular osteoporosis (wrist radiographs), narrowed joint spaces and erosions. Synovial biopsy has revealed suggestive features for juvenile idiopathic arthritis (JIA). According to diagnosis, the treatment has included physical therapy, anti-inflammatory drugs and methotrexate. Even under methotrexate therapy, the joint function has deteriorated with hand fingers progressive ankylosis. The biologic therapy (etanerceptum) has been initiated with improvement of joint mobility, synovial inflammation and osteoporosis, too. Conclusions: The patient was misdiagnosed as rheumatic fever due to high ASLO titers that can be explained by polyclonal and non-selective B lymphocytes activation. In this case, ASLO titer was correlated with disease's activity. The case peculiarity: it's important to consider the JIA diagnosis for cases with persistent high ASLO titers and unresponsiveness to penicillin therapy.