We report the case of a six-year-old girl who consulted the health center for right knee pain without inflammatory signs or history of trauma.
He was treated with ibuprofen and three months later he returned to the consultation with progressive pain and inflammation of the fifth metatarsal of the right foot that limited his walking.
Later there was pain and inflammation on the back of the right hand.
Associated with previous influenza-like illness, gastrointestinal infection or urinary symptoms, the patient was afflicted at all times.
One week later, the patient came to the clinic due to persistent symptoms and functional impotence to maintain standing.
Her personal and family history and pregnancy were not clinically relevant.
His psychomotor development was normal.
The patient had a weight of 23.5 kg, height of 122 cm, heart rate of 74 bpm and acceptable general status.
On examination, pain, inflammation, and limited flexion due to pain at 90° were observed, as well as tenderness of the right foot, with no pain in the fifth hand and mild metaphalangeal inflammation of the right knee.
No vascular-nerve deficit.
Physical examination revealed no rash, adenopathies, or visceromegaly.
The radiographs were normal at all times.
Analytical: mild thrombocytosis (425 000/μl), without leukocytosis or neutrophilia, C-reactive protein 13 mg/ml, erythrocyte sedimentation rate 52, antinuclear antibodies (ANA) negative to 1/160.
Arthrocentesis was performed (biochemistry and culture) obtaining inflammatory fluid with 5360 cells/ml, glucose 69 mg/dl, protein 5.4 g/dl and negative culture.
Treatment with ibuprofen was initiated at a dose of 200 mg every eight hours, waiting to be evaluated by the specialist, with a slight improvement.
A pediatric rheumatology evaluation was requested, which extended the analytical approach, performed the diagnostic test, and initiated treatment with dementia.
The extended blood test yielded negative results for anti-cyclic citrullinated peptide antibodies, ANSD, HLA B27 and serology hepatitis B and C. The results were also normal in the thyroid tests, the uroanalysis
One month later, she was reviewed by Pediatric Rheumatology and was diagnosed with right knee arthritis ANA(+) and probable JIA, due to persistent inflammation and pain in the right knee and tarsal.
The study was completed with foot ultrasound and corticosteroid withdrawal.
The ultrasound was normal and showed a good evolution after implantation.
