Challenge for timely diagnosis of juvenile idiopathic arthritis in children

Correspondence: Canadian Paediatric Surveillance Program, 2305 St Laurent Boulevard, Ottawa, Ontario K1G 4J8. Telephone 613-526-9397 ext 239, fax 613-526-3332, e-mail cpsp@cps.ca Accepted for publication February 11, 2008 Afour-year-old girl was referred to the paediatric rheumatology clinic for evaluation of a limp. She was previously well until eight weeks before her initial presentation when her parents noted that she was limping, particularly in the morning. She seemed reluctant to walk down the stairs, became more whiny and frequently asked to be carried. Later in the day, she was seen running around the playground normally. She had no fever, rash or other constitutional symptoms. On physical examination, the family doctor noted a large left knee effusion and referred the child to a local orthopaedic surgeon. The surgeon examined her two weeks later and offered a diagnosis of ‘probable meniscal tear, no evidence of septic arthritis’. A magnetic resonance imaging (MRI) screen was ordered. Four weeks later, the MRI was performed, but it was incomplete because of the child’s age and the decision not to use contrast media. The MRI report showed a joint effusion of the left knee, and the child was referred to a paediatric rheumatologist. At the time of the evaluation in the paediatric rheumatology clinic (four months after symptom onset), the child had a large left knee effusion with a 30-degree flexion contracture. Her gait was antalgic and painful. She was diagnosed with oligoarticular juvenile idiopathic arthritis (JIA), and was also found to have bilateral anterior uveitis by the paediatric ophthalmologist.