The association between Turner's syndrome and juvenile rheumatoid arthritis

Background. Turner's syndrome (TS) is a chromosomal disease frequently asso ciated with autoimmune conditions including thyroid disease, inflammatory b owel disease, and diabetes. Recent reports have described an association wi th juvenile rheumatoid arthritis (JRA) and psoriatic arthritis. We describe three additional cases of TS associated with JRA. Objective. The objective of this report is to describe the radiographic and clinical features of TS associated with JRA to heighten awareness of this association and alert radiologists to recognize the superimposition of radi ographic bony changes of chronic joint disease and the bone changes of TS. Patients and methods. Clinical history and radiographic images of three gir ls with TS and arthritis were reviewed. The radiographic findings typical o f TS and juvenile arthritis are described. Results. Of about 65 patients at our center with Turner's syndrome 3 had JR A (as described in this report), supporting the association between TS and JRA. All our patients who met American College of Rheumatology Classificati on criteria for JRA had radiographic and clinical findings consistent with both their JRA and Turner's syndrome. Conclusion. We believe that it is important to consider the diagnosis of Tu rner's syndrome in girls with JRA, recognizing that characteristic radiogra phic findings such as metacarpal shortening are usually present. Conversely , suspicion of an underlying inflammatory arthritis is warranted in search for radiological findings consistent with JRA in girls with TS and joint sy mptoms.