A RARE CLINICAL CASE OF DESTRUCTIVE ARTHRITIS OF THE FIRST
METATARSOPHALANGEAL JOINT AS A VARIANT OF THE ONSET OF ENTESITIS-RELATED ARTHRITIS IN A PUBERTAL GIRL
Kozhevnikov A.N.1,2, Chikulaeva E.V.1, Semenov S.E.1, Pozdeeva N.A.3, Novik G.A.2
1 - H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery.
2 - Saint Petersburg State Pediatric Medical University.
3 - Children's clinic № 49. Saint Petersburg, Russia.
Enthesitis-related arthritis is one of the subtypes of juvenile idiopathic arthritis, which is characterized by enthesitis and axial manifestations. Clinical manifestations of enthesitis-related arthritis are variable and similar to orthopedic pathology which determine the delay of diagnosis.
Purpose. To demonstrate the difficulties in diagnosing the destructive arthritis of the metatarsophalangeal joint of the great toe as a variant of the onset of enthesitis-associated arthritis in a pubertal girl.
Materials and methods. This article presents a clinical case describing the successful treatment of a 15-year-old girl with an atypical onset of enthesitis-related arthritis in the form of destructive arthritis of the first metatarsophalangeal joint. The child received treatment for hallus valgus for a long time. The juvenile idiopathic arthritis was diagnosed by the biopsy and classified as a pauciarticular variant. The combination of methotrexate and anti-TNF etanercept was efficacy. Enthesitis-related arthritis was revealed after 1.5 years treatment due to appear of axial lesion. The clinical manifestations of sacroiliitis reduced after switching to the anti-TNFgolimumab treatment.
Results and discussion. The clinical picture of enthesitis-related arthritis can be highly variable. A feature of the juvenile onset is the prevalence of peripheral enthesitis and delayed appearance of axial lesion. Foot lesions in children typically present as tarsitis or combined of the forefoot and mid-foot. Monoarthritis of the first metatarsophalangeal joint is extremely rare in children with enthesitis-related arthritis. In most cases, first metatarsophalangeal joint involvement occurs with polyarthritis and causes by hallux valgus.
Conclusion. Enthesitis-related arthritis is a special subtype of JIA with a variety of heterogeneous forms. Diagnostic delays arise in patients with rare or atypical forms onset of juvenile arthritis.
Keywords: enthesitis-related arthritis, destructive arthritis of the first metatarsophalangeal joint, sacroiliitis.
Corresponding author: Kozhevnikov A.N., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Kozhevnikov A.N., Chikulaeva E.V., Semenov S.E., Pozdeeva N.A., Novik G.A. A rare clinical case of destructive arthritis of the first metatarsophalangeal joint as a variant of the onset of entesitis-related arthritis in a pubertal girl. REJR 2026; 16(2):189-204. DOI: 10.21569/2222-7415-2026-16-2-189-204.
Received: 23.03.26 Accepted: 01.08.26