Muscular Atrophy and Limb-length Discrepancy Complicating Pauci-articular Juvenile Idiopathic Arthritis in a 14-year-old in Abeokuta, Nigeria: A Case Report and Review of Literature

Background

Juvenile idiopathic arthritis (JIA) is a chronic autoimmune inflammatory joint disease. It is the most common form of arthritis in children and adolescents. It is classified as pauci-articular, poly-articular, and systemic onset disease depending on the number of joints involved as well as presence of systemic symptoms. Pauci-articular JIA commonly involves large joints such as the knee joint, and typically manifests clinically with pain, swelling, tenderness and joint stiffness. Promptly diagnosed and appropriately managed JIA typically has an excellent prognosis while poorly treated cases may result in debilitating sequelae such as uveitis, ipsilateral muscular atrophy, limb-length discrepancies, and flexion-contracture deformities at the involved joint(s).

Objective

To review literature and report a case of muscular atrophy and limb-length discrepancy as rare complications of poorly managed JIA.

Methodology

We report a case of JIA in a 14-year-old female who presented with a three-year history of recurrent right knee pain, asymmetry of the thighs of two years duration and abnormal gait observed 18 months prior to presentation. Physical examination revealed an antalgic gait as well as thigh circumference and lower limb-length discrepancies.

Results

Anti- nuclear antibody (ANA) was positive, rheumatoid factor (RF) was negative; ultrasound scan of the right knee joint revealed sonographic features that were in keeping with arthritic changes, while plain radiograph of the knee joint revealed right knee effusion with overlying soft tissue swelling.

Conclusion

This report highlights and reviews limb-length and thigh circumference discrepancies as complications of pauci-articular JIA in children and adolescents.