JIA or reactive arthritis

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JIA or reactive arthritis

Author: Pediatric Oncall

Question
A 10-year-old boy presented with recurrent joint pain and swelling for 7 years. It started with left knee swelling at the age of 3 years apparently precipitated by a fall. The swelling persisted for 1 year in spite of taking medicine following which aspiration of the joint was done and the swelling subsided. The patient was then all right till 6 months ago when he developed pain in both the heels and ankles associated with swelling followed by pain over the cervical spine and clavicles. There is no rash, involvement of other joints, or mouth ulcers. There is difficulty in walking. On examination, he had bilateral ankle swelling with tenderness and terminal flexion restriction at the cervical spine. Other examination findings were normal. The child had received Prednisolone and anti-inflammatory drugs for the last month for the above complaints. His investigations done 1 month ago were:
Hemoglobin = 8.4 gm/dl
WBC count = 10,400/cumm [55% polymorphs, 39% lymphocytes, 5% eosinophils]
Platelets = 7,19,000/cumm
ESR = 131 mm at end of 1 hour
RA Factor = Negative
HIV = negative

His present investigations showed
Hemoglobin = 9.3 gm/dl
WBC count = 15,100 [60% polymorphs, 36% lymphocytes, 4% eosinophils]
Platelet count = 7,06,000/cumm
ESR = 30 mm at end of 1 hour
Eye examination = No iridocyclitis
ANA, ds DNA = Negative
X-Ray Ankle = Normal

The child was started on Naproxen and steroids were tapered. He was given diathermy for his ankle pains following which his condition improved and he was advised regular follow up.

Is this juvenile idiopathic arthritis or reactive arthritis?