A 10-year-old girl presents with symmetric arthritis of the interphalangeal joints of both hands and wrists for 10 weeks, uveitis (anterior chamber flare), and mild hepatosplenomegaly. ANA is positive at 1:320. RF is negative. Ferritin is 180 ng/mL. What is the most likely diagnosis and the greatest risk associated with uveitis in this condition?
- A Oligoarticular JIA — band keratopathy and vision loss from chronic iridocyclitis
- B Systemic JIA — macrophage activation syndrome
- C Polyarticular RF-negative JIA — band keratopathy from chronic asymptomatic uveitis ✓
- D Psoriatic JIA — dactylitis and nail pitting
Explanation
This child has polyarticular RF-negative JIA (≥5 joints affected for ≥6 weeks, RF negative, age <16 years). ANA positivity is seen in 25–40% of JIA patients and, combined with young age and female sex, identifies patients at high risk of chronic asymptomatic anterior uveitis (iridocyclitis), which can cause band keratopathy (calcium deposits in the cornea), posterior synechiae, and irreversible vision loss if unmonitored. The uveitis in JIA is typically insidious and asymptomatic, mandating routine slit-lamp examinations. Systemic JIA presents with quotidian fever, salmon-coloured rash, and high ferritin (>10,000 ng/mL in MAS).
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.