%0 Journal Article
%T Rhupus arthropathy as the presenting manifestation in Juvenile SLE: a case report
%A Erbil Unsal
%A Ayse Arl£¿
%A Hakk£¿ Akman
%J Pediatric Rheumatology
%D 2007
%I BioMed Central
%R 10.1186/1546-0096-5-7
%X Systemic lupus erythematosus (SLE) is an episodic, multisystem, autoimmune rheumatic disease characterized by diversity of both clinical and immunological abnormalities [1,2]. Arthralgia and arthritis affect the majority of children with SLE [1]. The arthritis is characteristically short in duration, lasting 24 to 48 hours, and can be migratory [1]. In some children, the arthritis is persistent and is characterized by swelling, tenderness, and loss of range of motion. Although the synovitis of SLE may be minimally proliferative, it is only occasionally erosive and usually does not result in permanent deformity [1]. SLE can mimic JIA, especially when it is presented as chronic and erosive arthritis. A young lady with chronic oligoarthritis is presented here, whose clinical picture eventually turned out to be typical lupus.An 8.5 year-old-girl was referred with swelling of both knees lasting for two years. She did not have complaints in any other joints. On her first examination, she was growing well. She had bilateral effusions of the knees (figure 1), and the other joints and systems were normal. MRI of both knees with gadolinium demonstrated chronic inflammation with synovial thickening (figure 2 and 3), suggesting erosive arthritis. Initial laboratory results revealed normal complete blood count (CBC), urine analysis, complement levels and immunoglobulin levels. ANA was also negative. She was diagnosed as oligoarticular JIA; naproxen was commenced, and she was regularly followed at 3 month intervals. She did not have any symptoms consistent with lupus such as alopecia, facial rash or oral ulcers. After two years of follow-up, she had a flare-up of arthritis in the knees, and epistaxis at the age of 10.5 years. Laboratory results revealed thrombocytopenia (23,000/mm3), coombs negative anemia (Hb: 10.7 g/dl), and normal WBC count (5900/mm3). ANA was positive (1/1280, speckled pattern), anti-dsDNA level was 1/20 positive, rheumatoid factor level was 9.88 IU/ml (0¨C14
%U http://www.ped-rheum.com/content/5/1/7