Five year follow-up of a prospective cohort of juvenile chronic arthritis with recent onset

Abstract

One hundred and fifty children with unsuspected juvenile chronic arthritis (JCA) and a disease duration of 3-6 months entered a prospective study. Diagnosis of JCA could be verified in 107 patients according to the WHO-EULAR criteria. After 5.0 +/- 0.9 years 66 of the 107 patients showed no disease activity, 24 of them for more than 2 years, 23 for less than 2 years without any drug therapy. Nineteen patients were still on NSAIDs and/or long acting drugs, 14 patients with unfavourable morphologic outcome (greater than stage II) and 17 patients with severe functional impairment (greater than or equal to stage III) all belonged to the 41 children with still active disease after 5 years follow-up. The disease course was polyarticular in 10 of the 14 patients with severe radiologic changes and in 14 of the 17 with unfavourable functional results. The wrist joint proved especially vulnerable since 46% of the severe radiologic changes concerned this joint. All 4 children with positive rheumatoid factor followed a polyarticular course with severe radiologic changes (stage greater than II), 3 of them together with unfavourable functional outcome. Risk factors for morphologically and functionally unfavourable course are therefore seen in a still active disease after 5 years, a polyarticular joint involvement and a positive rheumatoid factor. Extra-articular complications concerned chronic iridocyclitis in 7 patients, acute iridocyclitis in 2, amyloidosis in 1 and growth retardation in 2 children. -The prospective study is to be continued.

Aetiological role of bacteria associated with reactive arthritis in pauciarticular juvenile chronic arthritis.

“…4 Peripheral blood lymphocyte response toyersinia (YE), chlamydia (CT), borrelia (BB), salmonella (SA), shigella (SH) and campylobacter (CJr) in patients with reactive arthritis (ReA) and juvenile chronic arthritis (7CA). Results given as mean(SD) …”

Evolution of Systemic Juvenile Arthritis During Long-Term Follow-Up

“…Это совер-шенно не согласуется с представлениями интерниста-рев-матолога о течении хронического артрита. Однако почти у половины больных исследуемой группы все же было от-мечено развитие деструктивных изменений суставов, кото-рое может быть связано с сохраняющейся активностью за-болевания [11,37] и, безусловно, свидетельствует о необхо-димости продолжения терапии при наличии воспалитель-ных изменений у длительно болеющих ЮА.…”

What is low-dose corticosteroid therapy in juvenile idiopathic arthritis?

“…In cases of severe growth retardation below the 3rd percentile, however, the corticosteroid therapy is mostly the essential factor and not the disease itself (7,9). Some patients develop a specific adverse reaction at lower doses while others exhibit the same side effect only at higher doses.…”