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The present study reported high levels of D-dimer associated with multiple joint pain in a 5-year-old patient with systemic juvenile idiopathic arthritis (JIA). While treatment with methotrexate (MTX), hydroxychloroquine and methylprednisolone was found to reduce the D-dimer level and alleviated joint pain, the fever was not effectively controlled. Addition of etanercept to the treatment regimen from week 2 resulted in a clinical remission. Following 4-6 months of therapy, the D-dimer level of the patient returned to the normal range, and symptoms of noticeable joint pain and fever were absent. A literature search showed that the levels of D-dimer may be associated with JIA disease severity, and can serve as a prognostic biomarker for JIA treatment. In conclusion, the present study demonstrated that, while MTX therapy effectively reduced D-dimer levels, addition of etanercept to the treatment regimen was required to achieve a long-lasting remission of clinical symptoms, including fever.

Plasma levels of D-dimer in a 5-year-old girl with systemic juvenile idiopathic arthritis: A case report and literature review