case_images: PMC5818952_01
case_images: PMC5818952_02
case_images: Ultrasonography of the metacarpophalangeal joint of the right index finger. No remarkable findings were seen on a midline echo (a), but synovial fluid and power Doppler signals were noted on the radial-shifted view (b) and (c).
case_images: CRIRH2018-2164312.001.jpg
case_images: PMC5818952_02_CRIRH2018-2164312.001.jpg
case_images: fig1
case_images: Ultrasonography of the MCP joints indicated synovial fluid and power Doppler signals (Figure 1).
case_images: Radiography of both hands. (a) In September 2014, at the initiation of adalimumab when the patient was 12 years and 1 month of age. (b) In September 2016, after 2 years of adalimumab treatment when the patient was 14 years and 1 month of age. Narrowing of the metacarpophalangeal joints of both index fingers was observed when adalimumab was started (a), and more progressive joint space narrowing existed under treatment with adalimumab, whereas insignificant bone erosion was observed (b).
case_images: CRIRH2018-2164312.002.jpg
case_images: PMC5818952_02_CRIRH2018-2164312.002.jpg
case_images: fig2
case_images: Because the arthritis was refractory to another disease-modifying antirheumatic drug (3 mg/day of tacrolimus) and radiography showed progressive narrowing of the joint space of the MCP joints (Figure 2(a)), biweekly administration of 40 mg of adalimumab was initiated in September 2014, 14 months after the initial onset of JIIM when the patient was 12 years old. However, radiography in September 2016, after 2 years of adalimumab treatment, showed further progressive narrowing of the MCP joints that restricted dorsiflexion, whereas bone erosion was insignificant (Figure 2).
case_images: Time course of clinical treatments.
case_images: CRIRH2018-2164312.003.jpg
case_images: PMC5818952_02_CRIRH2018-2164312.003.jpg
case_images: fig3
case_images: Oral PSL was discontinued 10 months after initiation of adalimumab, and no significant fluid or power Doppler signals were observed on ultrasonography of the MCP joints performed 19 months after the drug's initiation (Figure 3).