Concurrence of juvenile idiopathic arthritis and primary demyelinating disease in a young child

Coşkun, Ayşe Nur; Günbey, Ceren; Göçmen, Rahşan; Turan, Kadriye Erkan; Sönmez, Hafize Emine; Özen, Seza; Anlar, Banu

doi:10.1016/j.msard.2018.10.002

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…This type of event is very rare in JIA. A recent single case report in the literature 14 reported a monophasic event of bilateral optic neuritis in a patient with JIA. To our knowledge, neither our case nor this reported case was exposed to a tumor necrosis factor alpha inhibitor medication (these medications have been reported to trigger demyelinating events).…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Pediatric Monophasic and Recurrent Idiopathic Optic Neuritis

et al. 2019

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Limited data exist on isolated optic neuritis in children. We report the clinical features and treatment of pediatric subjects with monophasic and recurrent idiopathic optic neuritis. This retrospective cohort study of patients with isolated optic neuritis identified 10 monophasic and 7 recurrent optic neuritis cases. Monophasic optic neuritis patients were older (mean 13.3 ± 4.22) than those with recurrent idiopathic optic neuritis (9.86 ± 3.63). Females represented 50% of monophasic and 85.7% of recurrent idiopathic optic neuritis cases. Patients with monophasic optic neuritis were less likely to have a bilateral onset than recurrent idiopathic optic neuritis (40% vs 57.1%). Only 1 case had oligoclonal bands in the cerebrospinal fluid CSF. Most recurrent idiopathic optic neuritis cases had evidence of anti–myelin oligodendrocyte glycoprotein (MOG) antibodies (5/7). Treatment of recurrent idiopathic optic neuritis cases included intravenous pulse glucocorticosteroids and immunotherapy. We observed differences between recurrent and monophasic idiopathic optic neuritis. Immunosuppression appeared to prevent further relapses in recurrent idiopathic optic neuritis patients. Weaning immunotherapies after several years of quiescence in recurrent idiopathic optic neuritis may be possible, but larger studies are needed.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Pediatric Monophasic and Recurrent Idiopathic Optic Neuritis

et al. 2019

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“…The coexistence of MS and JIA has been rarely reported, and it has not been systematically evaluated. In the literature, only few cases have been described, exclusively as anecdotal reports [ 89 , 90 , 91 , 92 , 93 ] ( Table 3 ). As a whole, available evidence is limited to five patients with coexisting JIA and MS. Of these subjects, only one patient had received a TNF inhibitor prior to MS onset [ 92 ].…”

Section: When Juvenile Idiopathic Arthritis and Multiple Sclerosis Co...mentioning

confidence: 99%

“…As a whole, available evidence is limited to five patients with coexisting JIA and MS. Of these subjects, only one patient had received a TNF inhibitor prior to MS onset [ 92 ]. Three other JIA patients developed demyelinating lesions after being treated with traditional synthetic DMARDs: methotrexate in two cases, leflunomide in one case [ 89 , 91 , 93 ]. In a single patient, the onset of MS occurred in the paediatric age: Coskun et al described the case of a 10-year-old girl with previous epilepsy and cognitive impairment due to cerebral palsy, who was diagnosed with JIA and later developed demyelinating attack after two doses of methotrexate.…”

Section: When Juvenile Idiopathic Arthritis and Multiple Sclerosis Co...mentioning

confidence: 99%

“…In a single patient, the onset of MS occurred in the paediatric age: Coskun et al described the case of a 10-year-old girl with previous epilepsy and cognitive impairment due to cerebral palsy, who was diagnosed with JIA and later developed demyelinating attack after two doses of methotrexate. At this regard, it should be highlighted that MS is rare at paediatric age, and the diagnosis should be carefully evaluated [ 89 ]. In paediatric patients, acute disseminated encephalomyelitis (ADEM) provides the most common demyelinating condition and represents a diagnostic challenge for paediatric neurologists.…”

Section: When Juvenile Idiopathic Arthritis and Multiple Sclerosis Co...mentioning

confidence: 99%

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Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review

et al. 2022

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Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.

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“…Systemic-onset JIA, previously known as 'Still's disease', is a minor subtype of JIA with rare eye involvement, which is characterized by arthritis and swinging pyrexia, erythematous rash hepatomegaly or splenomegaly, serositis, and lymphadenopathy [1]. Oculomotor nerve palsy in Kawasaki disease and multiple sclerosis-associated optic neuritis in JIA have been reported [4,5]. However, this is the first report of systemic-onset JIA after ischemic oculomotor palsy and optic neuritis, suggesting its immunologic predisposition.…”

mentioning

confidence: 99%

Acute Partial Oculomotor Nerve Palsy and Optic Neuritis Preceding Juvenile Idiopathic Arthritis: A Case Report

Chung

Lee

Kim

2021

Korean J Ophthalmol

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Concurrence of juvenile idiopathic arthritis and primary demyelinating disease in a young child

Cited by 5 publications

References 4 publications

Clinical Features and Outcomes of Pediatric Monophasic and Recurrent Idiopathic Optic Neuritis

Clinical Features and Outcomes of Pediatric Monophasic and Recurrent Idiopathic Optic Neuritis

Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review

Acute Partial Oculomotor Nerve Palsy and Optic Neuritis Preceding Juvenile Idiopathic Arthritis: A Case Report

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