Onset of polyarticular juvenile idiopathic arthritis with both anti-cyclic citrullinated peptide antibodies and rheumatoid factor in a 3-year-old girl

This report describes 3 year old girl with the unusual presentation of polyarticular juvenile idiopathic arthritis (jia) with anti-cyclic citrullinated peptide (anti-ccp) antibodies and a positive rheumatoid factor (rf). she was initially treated with a nonsteroidal anti-inflammatory drug (nsaid; ibuprofen) followed by methotrexate (mtx,10 mg/m2/week) and prednisolone (0.25 mg/kg/day),but these treatments were ineffective. administration of tocilizumab,a humanized antihuman interleukin-6 receptor monoclonal antibody,promptly improved her clinical manifestations,and she has been in complete remission (das28 <2.6) without bone erosion and/or destruction. positivity for both antibodies (anti-ccp and rf) can forecast the severity of jia (radiographic bone destruction). in such cases the administration of biologic remissive therapy may be prudent early in the disease course. © 2012 yasui et al.; licensee biomed central ltd.