Systemic onset JRA with multiple Arthritis, severe pain and prolong fever

An 11 year boy admitted in our hospital with fever for one and half months, severe pain and swelling of multiple joints. He has no recent history of sore throat, no family history of RA, no features of Psoriasis, no h/o contact with tuberculous patient, no h/o hear disease.

On examination, subcutaneous nodules over bony prominences, multiple, discrete, non tender, lymph nodes at different sites were found. There were no hepatosplenomagaly, no murmer, no bony tenderness and no bleeding manifestations .

He has anaemia, leucocytosis with neutropenia, high ESR. Urine analysis, Platelet, PBF, X ray of the chest and ECG were normal. Xray of the right knee joint shows soft tissue swelling, blood culture negative. ASO titre was 400 IU ( may be a coincidental finding of past streptococcal infection). RA factor abd ANF were absent.

Possibility of tuberculosis, leaukaemia, bacterial endocarditis were excluded.

The patient was level as Systemic onset JRA.

The patient was given tab Ibuprofen and 2 days later as the patient was not improving oral prednisolone was added.

One week after the admission the patient is now settled.


Bdoza