A 12 years old with polyarthritis

Author: Pediatric Oncall

Question
A 12-year-old boy presented with difficulty in walking for 6 months and fever and multiple joint swellings for 25 days. He had intermittent hip pain and knee pain. Now, for 25 days, he had swelling in the right ankle joint followed by involvement of the right mid interphalangeal joints, both shoulders, cervical spine, and bilateral knee joints. He had early morning stiffness with restriction of joint movements and was now unable to stand or sit. For the above complaints, he was admitted to a hospital and diagnosed to have TB hip synovitis in view of positive Mantoux test (12 x 10 mm) and treated with antituberculous therapy (ATT) and analgesics but there was no relief of symptoms. He had similar complaints 1 year ago that lasted for 2-3 months and responded to oral medications. Father has a history of joint pains and swellings and walks with crutches. On examination, the child was febrile, had joint pain and restriction over the cervical spine, right shoulder, right elbow, right middle interphalangeal joint, right hip, left knee, and right ankle with swelling over middle interphalangeal joints and right ankle. Systemic examination was normal. His investigations showed anemia with a drop of hemoglobin by 3 gm% in 3 months (12.3 mg/dl ? 9.6 mg/dl), normal WBC and platelet count, and ESR of 144 mm at end of 1 hour. His Albumin was low (2.4 gm/dl) and liver and renal function tests were normal. His ANA, RA factor, and ASCA were negative. X-Ray Chest and joints were normal.

What is the treatment required?

What is the treatment required?

Answer Discussion :

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