A 17 year old with isolated proximal tibiofibular joint arthritis

Abstract

The proximal tibiofibular joint (TFJ) is rarely affected in rheumatic diseases, and we frequently interpret pain of the lateral knee as the result of overuse or trauma. Nonetheless, the TFJ is a synovial joint that communicates with the tibiofemoral joint in a proportion of patients. While proximal TFJ arthritis has been rarely associated with existing spondyloarthritis, isolated TFJ arthritis as the presenting manifestation of spondyloarthritis has not yet been described. Here, we report the clinical and radiographic presentation of an adolescent with chronic proximal TFJ arthritis heralding spondyloarthritis highly suggestive of ankylosing spondylitis.

Identifying acute lymphoblastic leukemia mimicking juvenile idiopathic arthritis in children

“…Because patients with ALL can occasionally have normal indices during the prodromal phase of the disease, a referral to a hematologist/oncologist should be considered for reasons other than joint pain or a lack of laboratory markers for inflammatory diseases. The literature primarily includes comparison of children with ALL and musculoskeletal symptoms versus children with JIA [6,7,12,[16][17][18][19]25]. Musculoskeletal pain, most often diffuse bilateral leg pain, among children with ALL is known to be associated with nearly normal hematologic counts, with the risk of misdiagnosis as JIA [9,14,25,26].…”

“…Previous studies comparing children with ALL and JIA primarily involved children with ALL and musculoskeletal symptoms [7,12,[16][17][18][19], and only two smaller studies involved children with ALL and arthritis versus JIA [20,21]. Different clinical and laboratory features have been noted, but a useful general approach to differential diagnosis has not been described.…”

Therapeutic advances in the treatment of vasculitis

“…The SHARE initiative represents an important major therapeutic contribution since it provides consensus guidance for the management of HSP and HSPN, amongst other vasculitides [ 8 ]. In anticipation that these will be published imminently, a brief overview of the SHARE management algorithm for HSPN is as follows.…”

“…Given that vasculitides are rare, conducting large randomised controlled trials using traditional clinical trial design is usually not feasible. There is, however, a need for a standardized approach to the management of these rare paediatric rheumatic diseases [ 8 ]. The SHARE (Single-Hub Access for Pediatric Rheumatology in Europe [ 8 ]) project has been set up to address this unmet need, and one of the main aims is to provide recommendations for the management of paediatric rheumatological diseases in European countries.…”

“…There is, however, a need for a standardized approach to the management of these rare paediatric rheumatic diseases [ 8 ]. The SHARE (Single-Hub Access for Pediatric Rheumatology in Europe [ 8 ]) project has been set up to address this unmet need, and one of the main aims is to provide recommendations for the management of paediatric rheumatological diseases in European countries. Within this context the SHARE vasculitis working group have recently provided consensus and (where possible) evidence-based statements to optimize and harmonize management of vasculitis (manuscript in preparation).…”