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Elbow monoarthritis: an atypical onset of juvenile idiopathic arthritis

A Marino1, I Pagnini, S Savelli

  • 1Unità di Reumatologia Pediatrica dell'Ospedale Pediatrico, A.O.U. Meyer di Firenze, Italy. achillemarino6@gmail.com

Reumatismo
|July 31, 2012
PubMed

Insights

Juvenile idiopathic arthritis (JIA) can present atypically. Three cases of elbow monoarthritis, a rare initial sign of oligoarticular JIA, highlight the need for vigilance in diagnosing this common childhood rheumatic disease.

Area of Science:

  • Pediatrics
  • Rheumatology
  • Immunology

Background:

  • Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children, often leading to disability.
  • Oligoarthritis, affecting four or fewer joints within six months, has a distinct subtype in children characterized by early onset, female predominance, and specific HLA associations.

Purpose of the Study:

  • To report three rare cases of exclusive elbow monoarthritis as the initial presentation of oligoarticular JIA.
  • To highlight the atypical onset of JIA and its diagnostic challenges.

Main Methods:

  • Case series describing three pediatric patients with JIA.
  • Clinical evaluation including inflammatory markers and antinuclear antibody (ANA) testing.
  • Magnetic Resonance Imaging (MRI) for synovial inflammation assessment.
  • Treatment with intraarticular corticosteroids, NSAIDs, and/or methotrexate (MTX).

Main Results:

  • All three patients presented with isolated elbow monoarthritis, a rare initial manifestation.
  • Elevated inflammatory markers were observed in all cases; two out of three were ANA positive.
  • MRI revealed synovial inflammation without bone involvement.
  • One patient achieved remission with intraarticular triamcinolone hexacetonide; the other two required NSAIDs and/or MTX for disease reactivation.

Conclusions:

  • Exclusive elbow monoarthritis is a very atypical initial sign of oligoarticular JIA.
  • These cases underscore the importance of considering JIA even with unusual presentations.
  • Early diagnosis and appropriate management are crucial for mitigating long-term disability in JIA.

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