A case of polyenthesitis：Clinical significance to assess the enthesitis in pediatric rheumatic diseases

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  • Takakura Maiko
    Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
  • Shimizu Masaki
    Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
  • Inoue Natsumi
    Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
  • Mizuta Mao
    Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
  • Yachie Akihiro
    Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan

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Other Title
  • 多発性付着部炎の1 例 ─小児リウマチ性疾患における付着部炎の評価の重要性─
  • 症例報告 多発性付着部炎の1例 : 小児リウマチ性疾患における付着部炎の評価の重要性
  • ショウレイ ホウコク タハツセイ フチャクブエン ノ 1レイ : ショウニ リウマチセイ シッカン ニ オケル フチャクブエン ノ ヒョウカ ノ ジュウヨウセイ

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Abstract

A 13-year-old girl was referred to us with a 3-year history of stiffness of bilateral thighs and arthralgia of bilateral knees, and also 2-year history of stiffness of bilateral hands and bilateral shoulder pain. Musculoskeletal ultrasonography revealed polyenthesitis with edematous changes around tendons in upper and lower extremities. 18FFDG PET revealed hot spots in entheses of upper and lower extremities, tendons of bilateral hands and bilateral ischial tuberosities. Magnetic resonance image with fat-suppressed T2-weighted revealed high intensity lesions in entheses and tendons with FDG accumulation. The diagnosis of polyenthesitis was made. Ibuprofen was started but her symptoms were not improved. Oral prednisolone （PSL） was added and her symptoms were improved. However, PSL was discontinued because of steroid myopathy. Recurrence of enthesitis occurred after stopping PSL. Adalimumab was started and finally remission was achieved. Polyenthesitis without synovitis is very rare. Enthesitis has not been recognized as a cause of arthralgia yet. We should remain aware of the possibility of enthesitis in patients with arthralgia.

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