title: Onset of polyarticular juvenile idiopathic arthritis with both anti-cyclic citrullinated peptide antibodies and rheumatoid factor in a 3-year-old girl.
abstract: This report describes 3 year old girl with the unusual presentation of polyarticular juvenile idiopathic arthritis (JIA) with anti-cyclic citrullinated peptide (anti-CCP) antibodies and a positive rheumatoid factor (RF). She was initially treated with a nonsteroidal anti-inflammatory drug (NSAID; ibuprofen) followed by methotrexate (MTX, 10 mg/m2/week) and prednisolone (0.25 mg/kg/day), but these treatments were ineffective. Administration of tocilizumab, a humanized antihuman interleukin-6 receptor monoclonal antibody, promptly improved her clinical manifestations, and she has been in complete remission (DAS28 <2.6) without bone erosion and/or destruction. Positivity for both antibodies (anti-CCP and RF) can forecast the severity of JIA (radiographic bone destruction). In such cases the administration of biologic remissive therapy may be prudent early in the disease course.
authors.affiliation: Department of Pediatrics, Hiroshima City Hospital, 7-33 Moto-machi, Naka-Ku, Hiroshima, 730-8518, Japan. k-yasui@city-hosp.naka.hiroshima.jp.
authors.forename: Kozo
authors.initials: K
authors.lastname: Yasui
authors.forename: Sonoko
authors.initials: S
authors.lastname: Sakata
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ochi
authors.forename: Shinji
authors.initials: S
authors.lastname: Itamura
authors.forename: Kenta
authors.initials: K
authors.lastname: Hirai
authors.forename: Mieko
authors.initials: M
authors.lastname: Takenaka
authors.forename: Osamu
authors.initials: O
authors.lastname: Mitani
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ogawa
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Iyoda