A Twist in the Diagnosis: Chronic Arthropathy Without Inflammation

Abstract

Reason for consultation and medical history A six-year-old boy was referred to pediatric rheumatology in 2017 due to recurrent episodes of joint swelling affecting his knees, elbows, wrists, and ankles. These episodes began approximately one year earlier and were intermittent, lasting several days to weeks. The swelling was symmetric, nonpainful, and not associated with significant morning stiffness or functional limitation. Between episodes, the patient returned to his baseline status, with no residual symptoms, and remained physically active, participating in age-appropriate activities without restrictions.

There was no reported fever, rash, red or painful eyes, oral ulcers, or constitutional symptoms such as weight loss or fatigue. No history of trauma or infection was identified as a trigger.

Before rheumatologic evaluation, no disease-modifying treatments had been initiated. Nonsteroidal anti-inflammatory drugs (NSAIDs) were prescribed occasionally, with mild improvement in swelling. Additionally, the patient received intra-articular glucocorticoid injections in both knees, without significant or sustained clinical improvement.

He was the first child of two White parents. Although no known consanguinity was reported, both parents originated from the same small, low-population town. His mother had autoimmune hypothyroidism, whereas his father was healthy, and no other significant familial conditions were reported.

Regarding his personal medical history, the patient had undergone surgery at age two years for bilateral trigger fingers affecting the third digit of both hands—an unusual presentation at that age and in the absence of trauma. Unfortunately, detailed surgical records were not available, although the postoperative course had been uneventful. Additionally, he had a diagnosis of lactose intolerance, with recurrent abdominal discomfort triggered by dairy.

Consent for the use of the patient's data and images was obtained from his parents. This case report was exempt from institutional review board approval.