Juvenile idiopathic arthritis in a premature baby: A rare ca
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Juvenile idiopathic arthritis (JIA) is chronic arthritis in children and adolescents. It is clinically diagnosed, which includes children under the age of 16 with arthritis for at least six weeks. Cases younger than six months of age are extremely rare.

A female premature infant was born at 29 weeks gestational age by normal spontaneous vaginal delivery because of premature rupture of membranes (PROM) and vaginal bleeding three days before the delivery with a birth weight of 1325 g. She was the first child of a 16-years-old mother. There were no other significant obstetric and familial histories. After birth, the premature infant was admitted to the neonatal intensive care unit (NICU). The physical examination at admission was normal with prematurity signs and all her vital signs were within the normal average. Because of the suspicion of infection, antibiotics were initiated. On the fourth day of life, enteral feeding was started via a nasogastric tube. A cranial ultrasound (CUS) examination was performed which was normal.

On day 21 of life, redness and swelling appeared in the right elbow joint, with a circumference that exceeds the left by 2.5 cm with the absence of heat, and extra-articular symptoms. The peripheral pulse was palpable and other extremities were normal. X-Ray of the right elbow was performed which showed abduction between right Humerus and Forearm bones with edema in subcutaneous connective tissue. The right elbow Ultrasound demonstrated no effusion. The patient was treated with antibiotics for two weeks without any improvement.

On day 41, she developed swelling, redness, local heat, and slight pain on the mobilization of the right knee joint with limitation of movement. On day 57, inflammatory signs appeared in the left knee joint as swelling in other extremities improved.

Considering the clinical, serological, and radiology findings and according to JIA classification, oligoarthritis on day 64 was diagnosed and treated with prednisolone. All of the clinical and laboratory signs were improved and the patient was discharged after 10 days.

The patient was followed for year. During this year, the patient had arthritis only once at the age of 7 months. It was responding to (NSAIDs) and lasted for 2 days. Currently, the child is in good condition, all signs of inflammation are disappeared, good weight gain with good development in movement (stand with support) and the lengths of limbs are within the normal range.

Source: https://academic.oup.com/omcr/article/2020/11/omaa100/5999205