A 6-year-old girl presents with 6 weeks of arthritis involving more than 5 joints, including small joints of both hands and feet, knees, and ankles. She has low-grade fever. RF is negative. ANA is positive at 1:160. Eye examination is normal. Which JIA subtype does she have, and what is her GREATEST long-term ophthalmological risk?
- A RF-negative polyarticular JIA; risk of chronic asymptomatic anterior uveitis ✓
- B RF-positive polyarticular JIA; risk of progressive joint destruction
- C Systemic JIA; risk of macrophage activation syndrome
- D Oligoarticular JIA; risk of leg length discrepancy
Explanation
RF-negative polyarticular JIA in a young ANA-positive girl carries a high risk of chronic asymptomatic anterior uveitis — it can progress silently to band keratopathy, cataracts, glaucoma, and blindness without redness or pain. Regular slit-lamp examinations are mandatory (every 3–6 months) regardless of ocular symptoms. RF-positive polyarticular JIA resembles adult RA with RF positivity and erosive disease but has a low uveitis risk. Systemic JIA has MAS as the major complication. Oligoarticular JIA (≤4 joints) also has high uveitis risk, especially in young ANA+ girls, but this child has >5 joints involved.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.