A 9-year-old girl develops persistent arthritis in her right knee and left wrist for more than 6 weeks, with morning stiffness but no systemic features. ANA is positive at 1:320. She is at highest risk for which serious complication?

• A Macrophage activation syndrome
• B Asymptomatic anterior uveitis ✓
• C Pericarditis and serositis
• D Amyloidosis

Explanation

This child has oligoarticular juvenile idiopathic arthritis (JIA), the most common subtype in young girls. High-positive ANA in oligoarticular JIA is a strong risk factor for chronic asymptomatic (non-granulomatous) anterior uveitis (iridocyclitis), which can progress silently to band keratopathy, posterior synechiae, glaucoma and blindness without any eye symptoms. All oligoarticular JIA patients require regular slit-lamp surveillance every 3–6 months. Macrophage activation syndrome (MAS) is the feared complication of systemic JIA (Still disease). Serositis occurs in systemic JIA or polyarticular RF+ disease.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.