Review Question - QID 218600

This patient's examination is concerning for an underlying systemic disease (such as Lyme arthritis or juvenile idiopathic arthritis). Painless loss of motion would support a diagnosis of JIA; the first line of treatment is disease modifying antirheumatic drugs (DMARDs).

Juvenile Idiopathic Arthritis is a chronic autoimmune inflammatory arthritis lasting greater than 6 weeks in a patient younger than 16 years of age that typically presents with morning joint stiffness and ocular infections. Diagnosis is one of exclusion. Treatment is usually immunomodulating drugs and frequent ophthalmologic exams. While this patient may have findings of an osteochondritis dissecans (OCD) of the elbow, his primary complaint (painless loss of motion) is more suggestive of an underlying systemic disease. An OCD typically presents with elbow pain that is activity related.

Marino et al. reviewed JIA. They reported that JIA is the most common chronic rheumatic condition in childhood and an important cause of short- and long-term disability. They concluded that cases of monoarthritis of the elbow may be an initial sign of oligoarticular JIA.

van Bergen et al. reviewed osteochondritis dissecans (OCD) of the elbow. They reported that an OCD is localized most commonly at the humeral capitellum and teenagers that engage in sports that involve repetitive stress on the elbow are at risk. They concluded that stable lesions can be initially treated nonoperatively while unstable lesions may require surgical intervention.

Incorrect Answers:
Answers 1&2: Arthroscopic microfracture or drilling is indicated in unstable type I and stable type II OCD lesions
Answer 4: Immobilization is indicated in stable type I OCD lesions
Answer 5: Synovectomy may be indicated in JIA that has failed nonoperative management