The association between Turner's syndrome and juvenile rheumatoid arthritis.
BACKGROUND
Turner's syndrome (TS) is a chromosomal disease frequently associated with autoimmune conditions including thyroid disease, inflammatory bowel disease, and diabetes. Recent reports have described an association with juvenile rheumatoid arthritis (JRA) and psoriatic arthritis. We describe three additional cases of TS associated with JRA.


OBJECTIVE
The objective of this report is to describe the radiographic and clinical features of TS associated with JRA to heighten awareness of this association and alert radiologists to recognize the superimposition of radiographic bony changes of chronic joint disease and the bone changes of TS. Patients and methods. Clinical history and radiographic images of three girls with TS and arthritis were reviewed. The radiographic findings typical of TS and juvenile arthritis are described.


RESULTS
Of about 65 patients at our center with Turner's syndrome 3 had JRA (as described in this report), supporting the association between TS and JRA. All our patients who met American College of Rheumatology Classification criteria for JRA had radiographic and clinical findings consistent with both their JRA and Turner's syndrome.


CONCLUSIONS
We believe that it is important to consider the diagnosis of Turner's syndrome in girls with JRA, recognizing that characteristic radiographic findings such as metacarpal shortening are usually present. Conversely, suspicion of an underlying inflammatory arthritis is warranted in search for radiological findings consistent with JRA in girls with TS and joint symptoms.
Wihlborg
C E
CE
University of Toronto, Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.
Babyn
P S
PS
Schneider
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D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications* / Q000000981:diagnostic imaging; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging; D002348:Carpal Bones / Q000000981:diagnostic imaging; D002648:Child; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging; D005385:Fingers / Q000000981:diagnostic imaging; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging; D008663:Metacarpus / Q000000981:diagnostic imaging; D008682:Metatarsal Bones / Q000000981:diagnostic imaging; D010024:Osteoporosis / Q000000981:diagnostic imaging; D011859:Radiography; D014424:Turner Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000235:genetics; D014955:Wrist Joint / Q000000981:diagnostic imaging