Work

A case of a patient with oligoarticular juvenile idiopathic arthritis who developed a systemic form of juvenile idiopathic arthritis following an infection

Year: 2024

Type: article

Abstract: Introduction: Juvenile idiopathic arthritis (JIA) is an auto immune inflammatory joint disease of unknown etiology that develops before the age of 16.Case description: A 24yearold man, diagnosed with oligo articular JIA at age 13, was admitted to the Rheumatology Clinic in June 2023 due to painful swelling of left elbow, right knee, and right ankle.Two weeks before hospitalization, the patient experienced diarrhea and a purulent discharge from the urethra.Previously, he was treated with sulfasala zine, methotrexate, adalimumab, which were discontinued due to low disease activity.A relapse of symptoms occurred in July 2020, leading to the reintroduction of sulfasalazine, which was replaced by methotrexate in October 2020.Labo ratory tests at admission revealed elevated inflamma tory markers and signs of infection in the urine.Reactive arthritis was diagnosed.Treatment included antibiotics, NSAIDs, prednisone, and methotrexate at 15 mg per week, which reduced inflammatory markers.After one week, joint symptoms recurred along with gene ral symptoms such as fever, muscle aches, and sore throat.Inflammatory markers remained high, with increased ferri tin levels.Treatment included two courses of intravenous methylprednisolone (1 g/day).Despite this, symptoms quickly returned and inflammation increased again.Tocili zumab was introduced as part of the treatment regimen for systemic JIA, along with prednisone and methotrexate 20 mg per week.This led to overall improvement, reduced inflammation.Patient received tocilizumab intravenously every two weeks.After 3 months low disease activity was observed.Conclusions: In a patient with JIA, an infection triggered a relapse and generalization of the disease, necessitating a change in treatment and the introduction of tocilizumab.

Source: Reumatologia/Rheumatology

DOI: 10.5114/reum/193269

Authors: Grzegorz Chmielewski, Magdalena Krajewska-Włodarczyk

Institution: University of Warmia and Mazury in Olsztyn

Language: English

Topic: Autoimmune and Inflammatory Disorders Research

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4402873999