Juvenile rheumatoid arthritis in mono-zygotic twins

Abstract

Aim: To describe the rate of juvenile idiopathic arthritis progression and
to determine the degree of responsiveness to methotrexate and adalimmab
management in mono-zygotic twins with a methylene tetrahydrofolate
reductase gene mutation.
Methods: The study was a 5-month, twin concordance study. This
includes a retrospective study of medical records, activity and severity of
the disease, complications, which included an objective clinical examination
of the patient, based on an assessment of the severity of the disease
using the disease activity score calculator for rheumatoid arthritis (DAS:
28), liver function test, and folate cycle enzyme.
Results: Based on the study conducted, mono-zygotic twins with the same
form of arthritis, which began at the same age with the same manifestation
syndrome and joint disease, combined with the same folate cycle
mutation, with similar treatment regimen had different degrees of disease
progression and severity. The first twin had a complication of toxic hepatitis
and a concomitant autoimmune thyroiditis. The second twin had a
more serious progression with small joints ankylosis.
Conclusion: The study shows that monozygotic twins with juvenile idiopathic
arthritis with a similar defect in the folate cycle enzyme had different
rates of disease progression of varying severity and joint damage.
Consequently, this requires further study in monozygotic twins with juvenile
rheumatoid arthritis.