Falcini F, Taccetti G, Ermini M, Trapani S, Calzolari A, Franchi A, Cerinic M M
University of Florence, Italy.
Arthritis Rheum. 1997 Jan;40(1):175-8. doi: 10.1002/art.1780400122.
Rheumatoid nodules are a rare extraarticular manifestation of juvenile rheumatoid arthritis (JRA), usually detected in patients with polyarticular-onset disease and positive rheumatoid factor (RF). To date, there has not been a published report of rheumatoid nodules in systemic-onset JRA. Low-dose methotrexate (MTX) is generally considered to be the most useful second-line drug in the treatment of polyarticular JRA. In adult RA, MTX has been shown to be associated with appearance and progression of rheumatoid nodules. This report describes a 3-year-old girl with RF-negative, antinuclear antibody-negative systemic JRA who developed multiple rheumatoid nodules on the scalp and trunk during MTX therapy. The first nodule developed on the scalp 6 months after MTX treatment was initiated. Previous treatment with azathioprine was not associated with nodulosis. This represents an atypical case of MTX-associated accelerated nodulosis in systemic JRA, and raises the problem of treatment plan modification in the presence of this side effect.
类风湿结节是幼年类风湿关节炎（JRA）一种罕见的关节外表现，通常在多关节起病型疾病且类风湿因子（RF）阳性的患者中发现。迄今为止，尚未有关于全身型JRA出现类风湿结节的发表报告。低剂量甲氨蝶呤（MTX）通常被认为是治疗多关节型JRA最有效的二线药物。在成人类风湿关节炎中，MTX已被证明与类风湿结节的出现和进展有关。本报告描述了一名3岁女孩，患有RF阴性、抗核抗体阴性的全身型JRA，在MTX治疗期间头皮和躯干出现多个类风湿结节。第一个结节在开始MTX治疗6个月后出现在头皮上。先前使用硫唑嘌呤治疗与结节病无关。这代表了全身型JRA中MTX相关的加速结节病的非典型病例，并提出了在出现这种副作用时修改治疗方案的问题。
