A 4 yo WF was brought in by mother for L knee swelling, limp, and decreased activity starting 7 weeks ago.
Physical Exam
- Afebrile
- Well-appearing
- Left knee swelling with small effusion
- Other joints unremarkable
Diagnostic Workup
- CBC and CMP unremarkable
- Normal inflammatory markers
- ANA positive, RF negative
- Plain radiographs of L knee normal
Treatment
- Start weekly methotrexate
- Low threshold to add TNF inhibition if incomplete response to methotrexate
Referral
- Refer for an eye exam to screen for uveitis
A 12 yo F presents with joint pain in R knee and L hand for 2 months.
Physical Exam
- Afebrile
- Well-appearing
- R knee swelling with small effusion
- L hand with 3rd digit dactylitis
- Nail pitting on both hands
- DIPs of bilateral hands swollen, tender
Diagnostic Workup
- CBC and CMP unremarkable
- Normal inflammatory markers
- Mildly elevated inflammatory markers
- RF negative
Treatment
- Start weekly methotrexate
- Short course of oral steroids for symptom control
- Low threshold to add TNF inhibition if incomplete response to methotrexate
Referral
- Refer for an eye exam to screen for uveitis