Osteochondritis dissecans (OCD) is a condition described as separation of articular cartilage and sub-chondral bone due to necrosis. Although there are many theories to explain its cause, little is known as to why OCD occurs more often in children with Juvenile Idiopathic Arthritis (JIA). An active and healthy 11-year old female presented to the pediatric orthopedic clinic with a referral due to symptoms of sharp, stabbing pain in her right knee that began in late 2015. She injured her right knee twice, noticed the pain was different from her arthritic pain, and presented to the GP and received imaging. X-ray was benign, however an MRI showed subchondral lucency on the weight bearing portion of the lateral femoral condyle, two loose bodies, and joint effusion. The patient has a past medical history of JIA with active disease bilaterally in her knees, elbows, wrists, ankles, temporomandibular joints, and left mid foot. She has had 3 separate occasions where multiple joints became infected (septic arthritis) which included her knee’s. In the past she received Intra-articular corticosteroid (IACS) injections to both knees and is currently taking methotrexate, leflunomide, and plaquenil. The patient was brought to clinic, diagnosed with full thickness loss OCD, and proceeded with arthroscopic surgery. This case has many potential risk factors that could have led to the patient developing OCD (IACS injections, infection, JIA, etc.). It is unclear what can ultimately lead to OCD in patients with JIA, however there are many factors that require further research.
