A 6-year-old girl presents with 6 weeks of morning stiffness, swelling of 4 small joints (PIP joints bilateral hands), and both ankles. RF is negative. ANA is positive. She has no systemic features. According to ILAR classification, which subtype of Juvenile Idiopathic Arthritis (JIA) does she have, and what is the MOST important ophthalmological complication to screen for?

• A Systemic JIA (Still's disease) — screen for macrophage activation syndrome
• B Enthesitis-related arthritis — screen for acute symptomatic iritis
• C Psoriatic JIA — screen for posterior uveitis
• D RF-negative polyarticular JIA — screen for anterior uveitis (asymptomatic, slit-lamp examination required) ✓

Explanation

This presentation — oligoarticular or polyarticular arthritis in a young girl, ANA positive, RF negative, no systemic features — fits RF-negative polyarticular JIA (≥5 joints). The most critical complication to screen is chronic anterior uveitis (iridocyclitis), which occurs in 10–30% of polyarticular RF-negative JIA patients, characteristically ASYMPTOMATIC (no pain, redness, or photophobia) but detected on routine slit-lamp biomicroscopy screening. Untreated, it leads to band keratopathy, posterior synechiae, cataracts, and blindness. ANA positivity (as in this case) is the strongest risk factor for uveitis in JIA. Slit-lamp screening is mandatory every 3–4 months in high-risk JIA subtypes.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.