Juvenile idiopathic arthritis Quiz: Ace Your Exams
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An 8-year-old boy presents to the clinic with a 4-week history of intermittent fevers and a 3-week history of joint pain affecting both knees. The fevers come and go daily and when they are present, they are associated with an evanescent, macular, salmon-colored rash. The parents report that the child has been unwell with fatigue and reduced appetite over the past 4 weeks. They live near a wooded area and mention that the child had a tick bite several months ago. The child has had multiple visits to urgent care. He was prescribed a course of amoxicillin and laboratory studies were sent, which can be seen below. Vital signs are within normal limits. On examination, no rashes are currently present. Both knees are swollen, tender, and painful with passive and active range of motion. Generalized lymphadenopathy is noted. Which of the following is the most appropriate next step in management?
| Laboratory study | Result |
| White blood cells (WBC) | 22,000/m3 |
| Erythrocyte sedimentation rate (ESR) | 88 mm/hr |
| Antinuclear antibodies (ANA) | Negative |
| Rheumatoid factor | Negative |
| Ferritin | >1200 ng/mL |
| Lyme ELISA | Equivocal |
| Lyme IgM Western blot | 24 kDa band present |
| Lyme IgG Western blot | 18 and 21 kDa bands present |
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