Interactive Quiz: Joint Pain

First, let’s meet the patient…

A 4-month-old girl presented with signs of joint pain and hyperpigmentation of the skin over the joints. She had been born at 33 weeks of gestation via cesarean delivery due to fetal distress to a mother with a history of systemic lupus erythematosus (SLE). The pregnancy had been complicated by a maternal SLE flare requiring hydroxychloroquine treatment during the second and third trimester and by placental insufficiency leading to intrauterine growth restriction (IUGR).

The girl had remained in the neonatal intensive care unit (NICU) for 5 weeks with a relatively uncomplicated course, primarily working on feeding and growing. One week prior to discharge from the NICU, at 4 weeks of age, she was noted to have reduced movement at the shoulders, and raising her arms appeared to cause her pain.