What's the Diagnosis - Case 20

History 30 year old female with long standing history of decreased range of motion in multiple joints.

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Findings Radiographs of the elbow and both ankles show bony fusion across multiple joints, a profound degree of osteopenia, somewhat ballooned architecture to the ends of the bones, long standing radiocapitellar dislocation, and erosions and advanced arthrosis of both tibiotalar joints.

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Diagnosis: Juvenile Chronic Arthritis (JCA) JCA is a heterogeneous collection of inflammatroy arthropathies occuring in patients less than 16 years of age. It is typically divided into juvenile onset ankylosing spondylitis, juvenile onset psoriasis/inflammatory bowel disease, juvenile onset adult type RA, and Still’s disease. Still’s disease is then separated into pauciarticular, polyarticular, or systemic variants. Systemic implies serositis, renal disease, hepatosplenomegaly, and lymphadenopathy.

The radiologic findings of JCA are similar to adult onset RA except that typically JCA will involve the larger joints first (knees, ankles, and elbow) and the smaller joints of the hand and wrist later. The early findings of JCA are pronounced osteopenia and periarticular soft tissue swelling. With continued hyperemia to the joint there is a ballooning of the ends of the bones, and as the disease progresses, erosions and then ankylosis become present.

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Resources

• Resnick. Diagnosis of Bone and Joint Disorders. 4th Ed. 2002

• Brower. Arthritis in Black and White. 2nd Ed. 1997

• www.arthritis.co.za/jra.htm

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