Lepore Natasha, Cashin Megan, Bartley Debra, Ardelean Daniela Simona
Department of Pediatrics, University of Western Ontario, London, ON, Canada.
Lawson Health Research Institute, London, ON, Canada.
Pediatr Rheumatol Online J. 2017 Jan 13;15(1):2. doi: 10.1186/s12969-016-0129-x.
Oligoarticular juvenile idiopathic arthritis (oligoJIA), the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Severe oligoJIA monoarthritis presenting in a joint other than knees and ankles, is rare.
We report four children who presented with severe isolated arthritis of the hip, wrist or elbow and were diagnosed with oligoJIA. All four were girls with a median age of 11.5 years. Those with hip arthritis also met the classification criteria for juvenile-onset spondylarthopathy. Median duration of symptoms prior to diagnosis was 9.5 months. Three children had already cartilage loss or erosive disease at diagnosis.
Children diagnosed with oligoJIA that present with monoarthritis of the hip, wrist and elbow can have aggressive disease. Girls with positive HLA-B27 presenting with isolated hip arthritis could meet the classification criteria for both oligoJIA and juvenile-onset SpA. Early referral to specialized care may improve their diagnosis, treatment and outcome.
少关节型幼年特发性关节炎（oligoJIA）是儿童期最常见的慢性炎症性关节炎，通常累及膝关节和踝关节。严重的oligoJIA单关节炎出现在膝关节和踝关节以外的关节较为罕见。
我们报告了4例表现为严重的孤立性髋关节、腕关节或肘关节关节炎并被诊断为oligoJIA的儿童。4例均为女孩，中位年龄为11.5岁。患髋关节关节炎的患儿也符合青少年起病的脊柱关节病的分类标准。诊断前症状的中位持续时间为9.5个月。3例患儿在诊断时已出现软骨丢失或侵蚀性病变。
诊断为oligoJIA且表现为髋关节、腕关节和肘关节单关节炎的儿童可能患有侵袭性疾病。携带HLA - B27阳性且表现为孤立性髋关节关节炎的女孩可能同时符合oligoJIA和青少年起病的脊柱关节炎（SpA）的分类标准。早期转诊至专科护理可能会改善他们的诊断、治疗及预后。
