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A 10 year old African-American male was referred to rheumatology for evaluation of recurrent right knee swelling and warmth. His symptoms started at 18 months of age without antecedent trauma. Despite spontaneous resolution of his initial symptoms, over the next 8 years he experienced episodic swelling, warmth and later stiffness. In between episodes, the patient was able to play sports and ambulate without difficulty. He had no symptoms in any other joints, no constitutional symptoms and no chronic medical conditions.
His general physical examination was unremarkable. Synovitis was limited to the right knee, which was moderately swollen and warm to touch. There was no ligamentous laxity. Quadriceps muscle tone was equal bilaterally with no soft tissue masses identified. The patient had full passive …