A 6-year-old girl has 3 months of arthritis affecting both knees and both ankles (symmetric large joint arthritis) with morning stiffness lasting 90 minutes. She is ANA-positive (1:640), rheumatoid factor is negative, and anti-CCP antibodies are negative. She is at highest risk for which extra-articular complication, and how should it be monitored?
- A Macrophage activation syndrome; monitor ferritin and CBC monthly
- B Chronic anterior uveitis (iridocyclitis) which may be asymptomatic; requires slit-lamp examination every 3 months ✓
- C Pulmonary hypertension; echocardiography every 6 months
- D Serositis (pericarditis/pleuritis); annual chest X-ray and echocardiography
Explanation
This child has oligoarticular-extended JIA (juvenile idiopathic arthritis, polyarticular pattern with <5 joints affected initially, or extended pattern). ANA-positive JIA in young girls is strongly associated with chronic anterior uveitis (iridocyclitis) — critically, this uveitis is typically asymptomatic and can cause irreversible visual damage if undetected. ANA positivity is the most important risk factor for uveitis in JIA. Slit-lamp examination every 3 months is mandatory regardless of visual symptoms. Macrophage activation syndrome is a complication of systemic JIA. Pulmonary hypertension is associated with scleroderma-overlap JIA. The insidious, painless nature of JIA-associated uveitis — with no red eye — is a classic examination teaching point.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.