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Juvenile idiopathic arthritis — RACP Paediatrics MCQ

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ModerateRheumatology and dermatologyJuvenile idiopathic arthritisRACP Paediatrics

A 4-year-old has a swollen right knee for three months with morning stiffness but no fever. ESR is mildly elevated and ANA is positive; she has no rash or systemic symptoms. What is the most appropriate management?

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Correct answer: A — Paediatric rheumatology referral with NSAID therapy and slit-lamp screening

Persistent oligoarthritis in a young child is consistent with oligoarticular JIA; management includes rheumatology care, anti-inflammatory therapy and uveitis screening. Septic arthritis is usually acute, painful and systemic, not a three-month monoarthritis. The pearl is that ANA-positive young children with oligo-JIA are at risk of silent chronic anterior uveitis.

Reference: RCH Clinical Practice Guidelines; Australian rheumatology guidance