title: Atypical monoarthritis presentation in children with oligoarticular juvenile idiopathic arthritis: a case series.
abstract: BACKGROUND
  Oligoarticular juvenile idiopathic arthritis (oligoJIA), the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Severe oligoJIA monoarthritis presenting in a joint other than knees and ankles, is rare.
  
  
  RESULTS
  We report four children who presented with severe isolated arthritis of the hip, wrist or elbow and were diagnosed with oligoJIA. All four were girls with a median age of 11.5 years. Those with hip arthritis also met the classification criteria for juvenile-onset spondylarthopathy. Median duration of symptoms prior to diagnosis was 9.5 months. Three children had already cartilage loss or erosive disease at diagnosis.
  
  
  CONCLUSIONS
  Children diagnosed with oligoJIA that present with monoarthritis of the hip, wrist and elbow can have aggressive disease. Girls with positive HLA-B27 presenting with isolated hip arthritis could meet the classification criteria for both oligoJIA and juvenile-onset SpA. Early referral to specialized care may improve their diagnosis, treatment and outcome.
authors.affiliation: Department of Pediatrics, University of Western Ontario, London, ON, Canada.|Lawson Health Research Institute, London, ON, Canada.|University College Cork, Cork, Ireland.|Western Bone & Joint Institute, London, ON, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Lepore
authors.affiliation: Lawson Health Research Institute, London, ON, Canada.|Department of Surgery, Division of Orthopedic Surgery, London, ON, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Cashin
authors.affiliation: Lawson Health Research Institute, London, ON, Canada.|Department of Surgery, Division of Orthopedic Surgery, London, ON, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Bartley
authors.affiliation: Department of Pediatrics, University of Western Ontario, London, ON, Canada. dardelea@uwo.ca.|Lawson Health Research Institute, London, ON, Canada. dardelea@uwo.ca.|Western Bone & Joint Institute, London, ON, Canada. dardelea@uwo.ca.|Department of Medical Biophysics, University of Western Ontario, London, ON, Canada. dardelea@uwo.ca.
authors.forename: Daniela Simona
authors.initials: DS
authors.lastname: Ardelean
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology; D001171:Arthritis, Juvenile / Q000150:complications*; D002648:Child; D005260:Female; D006119:Groin; D006621:Hip Joint; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D059352:Musculoskeletal Pain / Q000209:etiology*; D016896:Treatment Outcome; D014955:Wrist Joint
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: Atypical monoarthritis; Children; Elbow; Hip; Presentation; Wrist; oligoJIA