When JDM patients complain of pain in the lower extremities, pediatric rheumatologists may initially consider this to be an exacerbation of myositis.
TIBIAL STRESS FRACTURE SKIN
Juvenile dermatomyositis (JDM) is a rare chronic inflammatory disease of childhood, characterized by skin involvement and proximal muscle weakness. In addition to preventing JDM patients from getting osteoporosis, we need to consider stress reactions when children with JDM complain of sudden shin pain. Their underlying disease and weakness, treatment with glucocorticoid and methotrexate, or inactivity may have resulted in these tibial injuries, and made these patients more predisposed than other children. We experienced 6 children with JDM who presented with shin pain, and who were diagnosed with tibial stress fractures or stress reactions. In all 6 patients, the tibial stress injuries improved with only rest and/or analgesics. In one patient, we could not find any abnormalities in his radiograph, but the subsequent MRI showed tibial stress reaction. They were diagnosed with tibial stress injuries based on a combination of radiographs, three-phase bone scans, and magnetic resonance imaging (MRI), and 5 out of 6 patients had been treated with prednisone and/or methotrexate at onset of tibial stress injuries. Case presentationĪll 6 patients with JDM presented with shin pain or tenderness in the anterior tibia without any evidence of excessive exercise or traumatic episode. Here we report 6 JDM patients who presented with shin pain, and the imaging appearance of tibial stress fractures or stress reactions. They sometimes occur in patients with pathological conditions of bone metabolism such as osteoporosis or rheumatoid arthritis, but there are previously no cases reported in juvenile dermatomyositis (JDM). Tibial stress injuries are frequent injuries of the lower extremity and the most common causes of exercise-induced leg pain among athletes and military recruits.
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