Acquired factor VIII inhibitor in juvenile rheumatoid arthritis

Children with juvenile rheumatoid arthritis (JRA) may develop an acquired circulating inhibitor to blood clotting factor VIII (FVIII), which has also been found in hemophiliacs. JRA is a chronic disease of children involving inflammation of the joints. A 19-year-old man with JRA whose FVIII activity was found to be very low was then found to have the acquired FVIII inhibitor. Patients with acquired FVIII inhibitor usually have bleeding complications similar to those seen in hemophiliacs. Eighteen pediatric cases of acquired FVIII inhibitor were found in the literature, but only this case described JRA as well. Aggressive early treatment with corticosteroids and, later on, cyclophosphamide, was given to this patient. Although rare, it is suggested that acquired FVIII inhibitor be considered as a cause of bleeding disorder in children with JRA.