Abstract
The case involved a 21-year-old woman with the chief complaint of arthritis in the left foot at the time of onset (10 years of age). Treatment was initiated with aspirin and weekly low-dose MTX. Rheumatoid factor (RF), which had been shown to be positive, rapidly became negative and the symptoms also subsided. Dry synovitis subsequently developed, which is a characteristic of extended oligoarthritis; arthritis was manifested in various areas and RF was also gradually elevated. Despite the use of various immune suppressors given in combination, improvement could not be maintained. Ten years after onset, the level of matrix metalloproteinase-3 was higher than 800 ng/ml; the level of anti-cyclic citrullinated peptide antibody was also as high as 83.3/Uml; additionally, severe destruction of the joint was predicted in the future, and thus administration of infliximab was initiated. Prior to infliximab administration, the DAS28-ESR was 6.0; however, it became 2.7 after 2 weeks and was markedly improved and maintainedafterwards. With regard to the HLA-DNA types of this case, HLA-DRB1*0405, a DR4 type prevalent among Japanese, HLA-DPB1*0201 prevalent in oligoarthritis, and HLA-A*02 prevalent in extended oligoarthritis, were detected. In juvenile idiopathic arthritis, RF-positive cases are excluded from the extended oligoarthritis category, and thus the classification of the disease type of RF-positive cases similar to our case became a task for the future. For cases of childhood showing resistance to various treatments during the course of the disease, it is important to determine the prognosis by HLA-DNA typing at the early stage, as well as to consider an use of biological agents.
