This 4-year-old girl's illness began when she was 3 years old. She complained of right-wrist pain that gradually worsened, leading to nonuse of the arm. The dorsa of her right hand and wrist became swollen and exquisitely tender, but she had no fever or other evidence of systemic disease. A hand/wrist roentgenogram showed normal bones. As right-wrist pain gradually subsided, her left wrist became swollen and painful and needed to be casted for about four months. Subsequently, she began to limp, followed by pain and swelling of her left foot. A biopsy of the articular capsule of her left wrist was done, and microscopic examination showed slight hypertrophy of the synovium. Her condition did not improve and three months later, at the age of 4 years, she was admitted to Clinica Pediatrica, Pavia, Italy.
She was normally developed but walked with difficulty and had stiff wrists. Her hair was short,