Delay in motor development as a presentation of juvenile rheumatoid arthritis

Abstract

during the acute phase of her illness, and her renal biopsy showed evidence of electron dense deposits and immune reactions by immunofluorescence. However, DNAase treatment would be expected to release any DNA antibodies that may have been hidden in complexes, and such treatment of our patient's serum did not increase the level of detectable DNA antibodies. It is possible that antibodies to nuclear components other than DNA were involved in immune complex production. Another possibility is ANA absorption by organs such as skin or kidneys? However, organ absorption is related to critical serum tilers and one would expect the ANA test to be positive sometime during the course of the disease. 1~ Finally, antibodies to non-nuclear antigens may be responsible for the described phenomenon. Antibodies to cytoplasmic proteins (e.g., Ro antigen) have been described in patients with ANA negative lupus. 11 These were not tested in our patient. In summary, although the ANA test is generally a useful screening test, ANA-negative systemic lupus erythematosus appears to be a distinct entity in the pediatric age group. In contrast to other reports, SLE associated with a negative ANA test may be clinically severe and rapidly progressive. We wish to emphasize the importance of suspecting this diagnosis on the basis of clinical criteria.