A 3 year old male child presented with multiple joint pain, swelling and deformity of 1 1/2 year duration with intermittent exacerbation of symptoms. There was also a history of fever during exacerbation of these episodes.
The child had not achieved his milestone of independent walking yet due to deformities in the knee and painful episodes of joint pain.
There is no family history of rheumatoid arthritis or any other arthritis. Examination revealed an almost symmetric swollen small joints of the hands and feet, with minimal tenderness and painful and restricted passive range of movement due to synovitis. Both knees had effusion, soft tissue swelling in the form of synovial thickening, flexion deformities of 20-30 degrees.
Similar involvement was seen in both elbows. Hip joints, spine, shoulders and costochondral joints were relatively spared. The child was afebrile at present. While a provisional diagnosis of juvenile inflammatory arthropathy (JIA) was being entertained, a general examination of the child revealed a massive splenomegaly, and neck examination revealed cervical lymphadenopathy.
These findings probed one to think of other differentials, such as Gauchers disease and periodic fever syndrome rather than JIA. Only further investigations would clinch the diagnosis.