若年性リウマチ (JRA) が疑われた両膝関節炎の一例
1997 年 46 巻 4 号 p. 978-982
詳細
1997 年 46 巻 4 号 p. 978-982
A 10 year-old complained of spiking fever and bilateral knee arthritis associated with hydroarthrosis and limited flexion of the knees.
On admission in May 1996, blood examination showed, WBC-6600/mm3, CRP-3.1mg/dl, ESR-27mm/hr, CH50-49U/ml and ASO-234-IU/ml.
Negative Rheumatoid factor and no change in the knee and wrist X-rays caused difficulty in the diagnosis of juvenile rheumatoid arthritis or septic arthritis.
Treatment with arthroscopic synovectomy of the knee reduced the idiopathic hydroarthrosis. The diagnosis of juvenile rheumatoid arthritis was made according to the arthroscopic findings and pathology of the synovitis.
After withdrawal of DMARD (Tiopronin 200mg/day) and NSAID (Diclofenac 50mg/day), the knees showed a significant functional improvement and inflammatory findings continuously disappeared.
Knee arthroscopy is an easily available examination which gives important information on the diagnosis of juvenile rheumatoid arthritis. Arthroscopic synovectomy was a valuable treatment for the highly active synovitis found in juvenile rheumatoid arthritic knees.
