Images in Clinical Rheumatology
Structural damage to the hip in systemic juvenile idiopathic arthritis: A case of regression with Anakinra
Daño estructural de la cadera en la artritis idiopática juvenil sistémica: un caso de regresión con Anakinra
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array:1 [ 0 => array:4 [ "autoresLista" => "Francisca Aguiar, Iva Brito" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Francisca" "apellidos" => "Aguiar" "email" => array:1 [ 0 => "francisca.ra@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Iva" "apellidos" => "Brito" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Rheumatology Department, Centro Hospitalar São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine of Porto University, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Daño estructural de la cadera en la artritis idiopática juvenil sistémica: un caso de regresión con Anakinra" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 705 "Ancho" => 1800 "Tamanyo" => 97774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior (Panel A) and frog-leg lateral (Panel B) radiographs of the pelvis showing left hip joint space narrowing, subchondral cysts of the left femoral head and acetabular sclerosis (*).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 15 years old caucasian girl was diagnosed with systemic juvenile idiopathic arthritis (sJIA) by the age of four and was initially treated with nonsteroidal anti-inflammatory drugs and oral corticosteroids (prednisolone 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day). Although there was some clinical improvement, the disease progressed with 1–2 articular and systemic exacerbations a year and, in the beginning of the year 2007, when she was 7 years old, she started weekly methotrexate (10<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span>).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite methotrexate treatment escalation (up to 25<span class="elsevierStyleHsp" style=""></span>mg/m<span class="elsevierStyleSup">2</span>/week subcutaneously) the patient had persistent disease activity and developed severe left coxitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) in the beginning of 2009, which did not respond to ultrasound guided joint injection with triamcinolone hexacetonide. Due to the persistence of arthritis and elevated inflammatory markers she was started on Anakinra (1<span class="elsevierStyleHsp" style=""></span>mg/kg/day) in July 2009.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Since then there has been sustained improvement with resolution of clinical symptoms, including complete imagiological regression of coxitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which allowed discontinuation of methotrexate and corticosteroids. The patient is in clinical remission on medication with Anakinra 100<span class="elsevierStyleHsp" style=""></span>mg/day (2–2.5<span class="elsevierStyleHsp" style=""></span>mg/kg/day) since 2011.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">sJIA is an autoinflammatory rheumathologic disease that accounts for 5–10% of all patients classified as JIA.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Hip involvement in sJIA is relatively common and is a cause of significant functional impairment and a marker of poor prognosis.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a> A significant number of patients with sJIA has persistent disease despite the treatments used.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Anakinra is a recombinant form of human IL-1 receptor antagonist (IL-1Ra) that is recommended as first line disease-modifying therapy in sJIA selected patients and in refractory disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> In this case, the authors report the therapeutic success with Anakinra in a patient with refractory systemic and articular disease, emphasizing the regression of structural damage of the hip joint, which is rarely reported in these cases.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-24" "fechaAceptado" => "2015-12-30" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 705 "Ancho" => 1800 "Tamanyo" => 97774 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior (Panel A) and frog-leg lateral (Panel B) radiographs of the pelvis showing left hip joint space narrowing, subchondral cysts of the left femoral head and acetabular sclerosis (*).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 754 "Ancho" => 1800 "Tamanyo" => 109147 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior (Panel A) and frog-leg lateral (Panel B) radiographs of the pelvis showing normal left hip joint space with discrete acetabular sclerosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Juvenile idiopathic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.J. Gowdie" 1 => "S.M. Tse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatr Clin N Am" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "301" "paginaFinal" => "327" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between impairments in joint function and disabilities in independent function in children with systemic juvenile idiopathic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.P. Bekkering" 1 => "R. ten Cate" 2 => "L.W. Suijlekom-Smit" 3 => "D. Mul" 4 => "E.A. van der Velde" 5 => "C.H. van den Ende" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2001" "volumen" => "28" "paginaInicial" => "1099" "paginaFinal" => "1105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11361196" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic onset juvenile chronic arthritis, polyarticular pattern and hip involvement as markers for a bad prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Modesto" 1 => "P. Woo" 2 => "J. García-Consuegra" 3 => "R. Merino" 4 => "M. Gracía-Granero" 5 => "C. Arnal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2001" "volumen" => "19" "paginaInicial" => "211" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11326488" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Ringold" 1 => "P.F. Weiss" 2 => "T. Beukelman" 3 => "E.M. Dewitt" 4 => "N.T. IIowite" 5 => "Y. Kimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.38092" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "2499" "paginaFinal" => "2512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24092554" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001300000002/v1_201703230043/S1699258X16000048/v1_201703230043/en/main.assets" "Apartado" => array:4 [ "identificador" => "42683" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Reumatología clínica en imágenes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001300000002/v1_201703230043/S1699258X16000048/v1_201703230043/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16000048?idApp=UINPBA00004M" ]
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