A case of oligoarthritis juvenile idiopathic arthritis in a 3-year-old male child: challenges in early diagnosis and management
Main Article Content
Keywords
Early Diagnosis, Juvenile Idiopathic Arthritis, Multidisciplinary Management, Oligoarthritis, Temporomandibular
Abstract
Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in children, characterized by persistent joint inflammation. However, early diagnosis is often challenging due to heterogeneous clinical manifestations. Among its subtypes, oligoarthritis is the most common, involving up to four joints within six months of symptom onset. This case is distinctive due to its very early onset at the age of 3 years, prolonged diagnostic delay despite multiple healthcare visits, and diagnostic challenges related to nonspecific initial symptoms. Delayed diagnosis can result in joint deformity, growth retardation, and long-term disability, highlighting the importance of early recognition and timely management.
Case Presentation: A 3-year-old male child presented with progressive joint pain, morning stiffness, and recurrent joint swelling that was initially associated with a history of trauma. Symptoms had been present since the age of 1.5 years, leading to a significant delay in definitive diagnosis. Based on clinical evaluation, imaging findings, and laboratory investigations, a diagnosis of oligoarticular Juvenile Idiopathic Arthritis was established according to the International League of Associations for Rheumatology (ILAR) criteria. The diagnostic process was further complicated by trauma-associated symptom onset and involvement of the temporomandibular joint (TMJ), which underscores the need for heightened clinical suspicion. The patient received multidisciplinary management, including pharmacological therapy, physical rehabilitation, and nutritional support.
Conclusion: This case illustrates the complexity of diagnosing and managing oligoarticular JIA in pediatric patients, particularly in cases with very early onset, delayed diagnosis, and TMJ involvement. A comprehensive multidisciplinary approach, along with increased clinical awareness and early diagnosis, is essential to control inflammation, preserve joint function, and prevent long-term complications in children with JIA.
References
2. Barut K, Adrovic A, Şahin S, Kasapçopur Ö. Juvenile idiopathic arthritis. Vol. 34, Balkan Medical Journal. Galenos Yayinevi Tic. Ltd. Sti.; 2017. p. 90–101. doi:10.4274/balkanmedj.2017.0111.
3. Zaripova LN, Midgley A, Christmas SE, Beresford MW, Baildam EM, Oldershaw RA. Juvenile idiopathic arthritis: from aetiopathogenesis to therapeutic approaches. Vol. 19, Pediatric Rheumatology. BioMed Central Ltd; 2021. doi:10.1186/s12969-021-00629-8.
4. Garner AJ, Saatchi R, Ward O, Hawley DP. Juvenile idiopathic arthritis: A review of novel diagnostic and monitoring technologies. Vol. 9, Healthcare (Switzerland). MDPI; 2021. doi:10.3390/healthcare9121683.
5. d’Angelo DM, Di Donato G, Breda L, Chiarelli F. Growth and puberty in children with juvenile idiopathic arthritis. Vol. 19, Pediatric Rheumatology. BioMed Central Ltd; 2021. doi:10.1186/s12969-021-00521-5.
6. Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: A systematic review. Vol. 81, Joint Bone Spine. Elsevier Masson SAS; 2014. p. 112–7. doi:10.1016/j.jbspin.2013.09.003.
7. Mclaughlin D, Keir M, Foster H, Jandial S. Chronic arthritis in children and young people [Internet]. 2022. Available from: www.pmmonline.org/doctor/. doi:10.1016/j.mpmed.2021.12.004.
8. Doya LJ, Bijow FW, Dayoub A. Juvenile idiopathic arthritis in a premature baby: rare case report. Oxf Med Case Reports. 2020 Nov 1;2020(11):399–401. doi:10.1093/omcr/omaa100.
9. Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, et al. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis and Rheumatology. 2016 Mar 1;68(3):566–76. doi:10.1136/annrheumdis-2015-208982.
10. Ogdie A, Coates LC, Gladman DD. Treatment guidelines in psoriatic arthritis. Rheumatology (United Kingdom). 2021;59:I37–46. doi:10.1093/rheumatology/kez383.
11. Ploesser M, Silverman S, Diaz JDL, Zincke MT, Taylor MB. The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review. Vol. 69, Seminars in Arthritis and Rheumatism. W.B. Saunders; 2024. doi:10.1016/j.semarthrit.2024.152558.
12. Muhsen A, Hertz A, Amital H. The association between physical trauma and autoimmune articular and dermatological disorders. Vol. 24, Autoimmunity Reviews. Elsevier B.V.; 2025. doi:10.1016/j.autrev.2024.103711.
13. Al-Allaf AW, Sanders PA, Ogston SA, Marks JS. A case±control study examining the role of physical trauma in the onset of rheumatoid arthritis. 2001. doi: https://doi.org/10.1093/rheumatology/40.3.262.
14. Armon K. Outcomes for juvenile idiopathic arthritis. Vol. 28, Paediatrics and Child Health (United Kingdom). Churchill Livingstone; 2018. p. 64–72. doi:10.1016/j.paed.2013.07.008.
15. Żuber Z, Opoka-Winiarska V, Smolewska E. Recommendations for the therapeutic management of systemic juvenile idiopathic arthritis. Opinion of the Section of Developmental Age Rheumatology of the Polish Society of Rheumatology. Rheumatology Forum. 2022 Jun 17;8(1):6–13. doi:10.5603/RF.2022.0002.
16. Foster HE, Kay LJ, Friswell M, Coady D, Myers A. Musculoskeletal screening examination (pGALS) for school-age children based on the adult GALS screen. Arthritis Care Res (Hoboken). 2006 Oct 15;55(5):709–16. doi:10.1002/art.22230.
17. Concannon A, Reed P, Ostring G. Incidence, Clinical Manifestations, and Severity of Juvenile Idiopathic Arthritis Among Maori and Pacific Island Children. Arthritis Care Res (Hoboken). 2019 Sep 1;71(9):1270–5. doi:10.1002/acr.23757.
18. Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, et al. Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Vol. 75, Arthritis and Rheumatology. John Wiley and Sons Inc; 2023. p. 4–14. doi:10.1002/art.42338.
19. Polizzi A, Quinzi V, Santonocito S, Palazzo G, Marzo G, Isola G. Analysis of earlier temporomandibular joint disorders in jia patients: A clinical report. Healthcare (Switzerland). 2021 Sep 1;9(9). doi:10.3390/healthcare9091140.
20. İşgüder R, Kızıldağ Z, Torun R, Aydın T, Makay B, Ünsal E. Risk of flare in juvenile idiopathic arthritis: Is it related to the methotrexate treatment strategy or patient characteristics? Arch Rheumatol. 2023 Dec 1;38(4):602–10. doi:10.46497/ArchRheumatol.2023.10035.