Juvenile Idiopathic Inflammatory Myopathy at a developing Paediatric Rheumatology Clinic in Trinidad and Tobago: a case series

Abstract

Objective: Juvenile Idiopathic Inflammatory Myopathy (JIIM) is a rare autoimmune disorder with no published data from the English-speaking Caribbean. As such, we seek to produce the first dataset from Trinidad and Tobago on this condition. Methods: Clinical notes of patients with JIIM, who attended the recently formed Paediatric Rheumatology Multi-Disciplinary Clinic over a 6-month period at the San Fernando Teaching Hospital were analysed. Clinically inactive disease at last visit was also assessed from the patients’ notes. Results: 5 patients clinical records were reviewed in this period. 4 were female and average age of onset was 6.8 years. 4 cases were Juvenile Dermatomyositis (JDM). The most common presenting complaints were skin rash and weakness whilst the most common additional symptoms were joint pains and pruritis. 2 patients had previous upper respiratory tract infection. Creatine Kinase was extremely elevated in one patient with juvenile polymyositis. 3 were positive for Antinuclear Antibodies. 2 patients were positive for Extractable Nuclear Antigen antibody (RP155). 3 patients utilized MRI which detected myositis in all reports. Oral medications included methotrexate and prednisolone. Parenteral drugs used included intravenous immunoglobulin and methylprednisolone. 4 patients had vitamin D supplementation and all 5 were prescribed physiotherapy. 2 had clinically inactive disease at last visit. Conclusions: This represents the first case series of JIIM in the English-Speaking Caribbean. Recommendations from this study include greater utilization of MRI in diagnostic workup and further evaluating anti RP155 antibody as a possible myositis associated antibody.

Keywords

• juvenile
• idiopathic
• inflammatory
• myopathy