A 6-month double-blind, parallel, randomized, placebo-controlled multicenter trial of auranofin (0.15-0.20 mg/kg/day) was conducted in 231 children with juvenile rheumatoid arthritis (JRA) in the United States and in the Union of Soviet Socialist Republics. Approximately 80% of the children had polyarticular disease. The auranofin-treated patients showed greater mean decreases from baseline in 11 of the 12 articular disease indices measured than did the placebo-treated subjects after 3 months of therapy, and in 9 of the 12 indices after 6 months. However, the actual intergroup mean differences were relatively small and were not statistically significant. According to the physician's global assessment, 69% of the auranofin-treated patients and 61 % of the placebo-treated patients demonstrated clinically significant improvement from baseline after 6 months (P = 0.24). Children whose disease onset occurred less than 2 years prior to entry improved more than did those who had arthritis for a longer period. In addition, those with polyarticular involvement at baseline improved more than did patients with mild disease. However, these relationships were observed in both the auranofin-and placebo-treated groups, and again, there were no significant intergroup differences. Diarrhea was the most common adverse effect of auranofin. We conclude that the clinical eflicacy of auranofin is modestly higher than that of placebo in the treatment of JRA, as evidenced by the consistent trends observed in the data. However, the magnitude of the individual intergroup differences is not statistically significant. Auranofin appears to be very safe in children with JRA. Articular disease activity is adequately controlled by nonsteroidal antiinflammatory drugs (NSAIDs) in approximately 5040% of children with juvenile rheumatoid arthritis (JRA). The rest of these children frequently experience more severe, progressive disease, and are considered to be candidates for slow-acting antirheumatic drugs (SAARDs). Goldcontaining compounds, D-penicillamine, and hydroxychloroquine represent thc 3 most frequently prescribed agents in this class of drugs. Recently, chrysotherapy has taken on added importance following the reports by Brewer et al(1) and Giannini et a1 (2) that neither D-penicillamine nor hydroxychloroquine, in the presence of NSAIDs, offers significant therdpeutic advantage over placebo plus NSAIDs in patients with JRA.Clinical evaluation of the oral gold preparation auranofin began in 1976 and to date, over 4,000 patients with adult rheumatoid arthritis (RA) have been entered into trials of its safety and efficacy (3). Studies in these patients have shown auranofin to possess a definite degree of efficacy over placebo, with a low incidence of severe toxicity (4-6). We have previously 468GIANNINI ET AL Informed consent. Prior to randomization, a parent or legal guardian of the child was asked to give informed consent. Patients who were 7 years or older were also asked to sign a modified consent document.Monitoring of efficacy and ad...

A bstvact. Objective, to describe a series of pts with JRA/JCA and uveitis. Material and methods. The study included 81 pts with JRA and uveitis. There were 68 girls-84%, 13 boys-16%. We studied the clinical manifestations, the antinuclear antibodies (ANA) using HEP-2 cells for the 33 pts with uveitis and 46 pts without uveitis, HLA status was determined for 36 pts. Results. 85,2% of the children had arthritis before uveitis. The mean age at onset of arthritis was 3,5 year (range: 1-10 yrs), the mean age at onset of uveitis was 6 year (range: 2-15 yrs). The mean interval between the onset of arthritis and uveitis was 3,02 years (range: 3,5 yrs before arthritis onset to 12,5 yrs after). In 68,1% pts the diagnosis of uveitis was made within 5 yrs after onset of arthritis. 93% of pts had mono-oligoarticular onset, but 50% had poliarticular course. 23,5% of pts had functional disability 3-4 classes. Ocular complications were developed in 53,1%: cataracts-38,3%, band keratopathy-11,1%, glaucoma-2,5%. 93,9% of 33 studied children with arthritis and uveitis were ANA positive, 9,1% were R F positive. 18,1 % had HLA-DR8 (p<0,001), 83,3% -HLA-A2 (p<0,001), HLA-B27 -30,6 % (p<0,001). Conclusion. Clinical and laboratory data of our pts suggest that: l)the com bination of arthritis and uveitis would be named JCA with uveitis; 2) according our opinion JCA with uveitis is separate nosological form am ong the juvenile arthritides.

На основании данных отечественной и зарубежной литературы, основанных на многолетнем опыте педиатров-ревматологов, представлены терминологические и классификационные аспекты ювенильного ревматоидного артрита (ЮРА). Изложены подходы к созданию диагностических и классификационных критериев ЮРА в будущем.