Multicentric carpotarsal osteolysis (MCTO), a skeletal dysplasia presents in early childhood mimicking juvenile idiopathic arthritis (JIA). Recognition of this syndrome is essential to avoid unnecessary treatment with immunosuppressive agents because of different course and treatment.
A 3-year-old boy presented with swelling and restriction of right wrist joint and left ankle joint. Possibility of Oligoarticular (or pauciarticular) JIA was considered. On evaluation his inflammatory parameters were normal. There was poor response to oral steroids and methotrexate. He was lost to follow up and presented at 9 years of age with varus deformities of hand and feet. Radiographs revealed absent carpal and tarsal bones. Based on clinical and radiological examination- MCTO was diagnosed. Oral alendronate was started and clinical improvement was noted.
Mimickers of JIA like MCTO, Farber’s disease should be actively looked when inflammatory parameters are normal or response to therapy is not appropriate.