Monoarticular JIA

Author: Pediatric Oncall

Question
A 9 years old boy presented with swelling over left knee joint for 2½ years. He had a history of trauma to the left knee 2½ years back following which there was swelling for 7 days. He was then alright for next 6 months when he again had left knee joint swelling with restriction of movement which has persisted till date. There is no history of fever, other joint involvement or sore throat. He has been treated with Injection Benzathine Penicillin in view of a positive ASLO titre. His echocardiogram is normal. On examination, there is swelling in left knee with synovial thickening and range of movement from 0-110o. Other systems are normal. X-Ray of the knee shows soft tissue swelling. RA factor is negative and ANA, dsDNA are also negative. CBC is normal (WBC count = 10,600/cumm with 73% polymorphs and 24% lymphocytes) and ESR is 9 mm at end of 1 hour). MRI of the knee shows synovial thickening with loculations in the synovial cavity. Bones are normal. A synovial biopsy showed chronic reactive synovitis without granulomatous change confirming the diagnosis of Monoarticular JIA.

How should this child be treated?

How should this child be treated?

Answer Discussion :

Ahmed Habib

Intra‑articular corticosteroid injection to the knee
e.g. triamcinolone hexacetonide (preferred for large joints).
Short course of NSAID
e.g. naproxen or ibuprofen for pain andinflammation.
Physiotherapy
maintain range of motion and muscle strength.
Consider synovectomy
only if chronic synovitis persists or recurs despite adequate steroid injections and NSAIDs.

8 hours ago

Shanthi Ananthakrishnan

Intraarticular steroid injections or synovectomy can be done. The child can be put on a short course of NSAID

24 hours ago

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Monoarticular JIA

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