Seropositive juvenile rheumatoid arthritis with Sjo gren's syndrome: features of diagnosis and treatment choice (a case report)

Abstract

The paper describes a clinical case of rheumatoid factor-seropositive polyarticular juvenile rheumatoid arthritis (JRA) concurrent with new-onset Sjo gren's syndrome (SS) in a teenage girl. It discusses the clinical features of SS and the problems of its diagnosis in pediatric practice. Erosive arthritis with rapidly progressive joint destruction concurrent with SS that was highly active according to biopsy findings, as well as the nature of the immunological parameters served as the basis for using rituximab (RTM), a chimeric anti-CD20 monoclonal antibody. Although RTM is not registered for use for this disease in childhood, an alternative biological agent was unavailable in this clinical situation. The therapy was observed to be highly effective. Just after the first cycle of RTM therapy, the values of acute-phase markers became normal, arthralgias and exudative joint phenomena diminished, and morning stiffness ceased. Twelve months after therapy initiation, the patient achieved remission of JRA with positive changes confirmed by control sialography and sialometry.

The given clinical example convincingly demonstrates the feasibility of using RTM in patients with JRA concurrent with SS with resistance to therapy with classical immunosuppressive drugs and with the undesirability of using tumor necrosis factor-а inhibitors due to the increased risk of lymphoproliferation in SS.