CASE REPORT

ALLERGY DIVISON

JUVENILE IDIOPATHIC OLIGOARTICULAR

Rusmelani Sain
 INTRODUCTION

 Juvenile idiopathic arthritis (JIA) is a general term

for all types of arthritis of unknown cause
 The primary pathology of the chronic disease is
inflammation of the connective tissues and is
characterized by swelling and pain.
 Factors that may be associated with some types of
JIA include girls predominantly, family history of
uveitis , ankylosing spondylitis, inflammatory bowel
disease, and family history of psoriasis
Case Report

 A case of juvenile idiopathicoligoarthritis in a 11-

year old and 1 month- girl entered the hospital on
October 10, 2019 because of swelling and pain in
the right knee .
 The Swelling and pain occured 10 days ago
before admission and the patient difficult to walk..
 Other complaints were unremakable
 The same complaints has been noted 5 months
age and medications were unregularly consumed
by the patient
Physical Examination

 General condition : moderately ill, undernourished , and consciousness child (GCS

15(E4M6V5)), her BW/H 33/37 x 100% (89 %/undernourished), her BW/A 145/145
x 100% (100 %/normal), and BB/A 33/38 x 100% (86%/ under nourished)
 Blood pressure 100/70 mmHg , heart rate104 /minute regular, adequate volume,
respiratory rate 20 /minute, regular, body temperature 36,7 o C, and : 2 NRS of pain
scale
There was swelling on the right knee, reddish, and warm on palpation.
 Strength of the muscle 5/5/4/5 and normal tone
 Physiological reflexes was normal and no pathological reflexes
 Laboratory results

 Laboratory results were normal

 Radiology Findings

 Radiology Findings were normal

 EKG and ECHO were normal

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Course of illness

 On day 1 of care
• Evidence of swelling and pain on the right knee
• Other signs and symptoms were unremakebly
• She was given Ibuprofen orally 200 mg/6jh and Calcium and vit D
supplementation

 On day 3 of care
• Evidence of swelling and pain on the right knee
• She was given Ibuprofen orally 200 mg/6jh and Calcium and vit D supplementation
• C3 komplemen 168, 6 mg/dl (80-150)

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Course of illness

 On day 4 of care
• Swelling and pain on the right knee
disappeared
• ASTO 386 IU/ ml (<200), RF 32,4 IU/ml (<30)
CRP 7,2 (<5) and blood smear showed signs of
infection
• She was given cefixime orally 100 mg/12h, Ibuprofen
orally 200 mg/6h and Calcium and vit D
supplementation
 On day 5 of care
• Swelling and pain on the right knee disappeared
• The patients discharged home to be followed up at
8 the RSWS’ polyclinic
CASE ANALYSIS
52% Oligoarthritis

JIA - Categories 16%Rheumatoid factor negative polyarthritis

15% Enthesitis-related arthritis

OLIGOARTHRICULAR TYPE:
• Affects up to 4 joints at presentation,
5% Psoriatic arthritis

with the knee joints mostly affected,

followed by the ankles. Systemic
5% arthritis (Still´s disease)

• This patients with knee joint

Rheumatoid
4% factor positive polyarthritis
oligoarthritis

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 CASE ANALYSIS
Diagnostic criteria
1) Age at onset <16 years
2) Duration of Arthritis: 6 weeks
3) Arthritis in one or more joints defined as swelling or effusion
4) Other conditions which present with arthritis in childhood must be
excluded

 This patient was diagnosed based on the above criteria

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 □ Nonsteroid anti-inflammatory drugs (NSAIDs)
such as Ibuprofen, Diclofenac.
□ Conventional DMARDs : Methotrexate,
Standard
Hydroxycloroquine, DMARDs Biologic
treatment for JIA Etanercept, TNF inhibitors,
□ Calcium supplementation 1000 - 1500 mg and
Vitamin D 400 IU daily
□ This patient was given ibuprofen and
Calcium supplementation 1000 - 1500 mg and
Vitamin D 400 IU daily

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 CASE ANALYSIS

COMPLICATIONS:
□ The joint’s damage and contracture
□ Macrophage activation syndrome.
□ Psychological problems: depression,
anxiety and problems in school

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CASE ANALYSIS

PROGNOSIS
□ Mortality

• In 1990  entire JIA group 0.29%systemic JIA 3%

• In 2010  entire JIA group 0.2%
 This patient was good in short term outcomes but uncertain in long term
prognosis

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Thank you

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