Juvenile Idiopathic Arthritis

Abstract

Juvenile idiopathic arthritis is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent fever and rash. Oligoarticular juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis. Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity arthritis. This disease subtype represents the childhood form of adult spondyloarthropathies, with human leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash, accompanied by arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and osteoporosis secondary to treatment and disease activity, to life-threatening macrophage activation syndrome with multi-organ insufficiency. With the advent of new therapeutics over the past 15 years, there has been a marked improvement in juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals of treatment are to eliminate active disease, to normalize joint function, to preserve normal growth and to prevent long-term joint damage. Timely and aggressive treatment is important to provide early disease control. The first-line treatment includes disease-modifying anti-rheumatic drugs (methotrexate, sulphasalazine, leflunomide) in combination with corticosteroids, used in different dosages and routes (oral, intravenous, intra-articular). Intra-articular application of steroids seems to be an effective treatment modality, especially in monoarthritis. Biological agents should be added in the treatment of unresponsive patients. Anti-tumour necrosis factor agents (etanercept, infliximab, adalimumab), anti-interleukin-1 agents (anakinra, canakinumab), anti- interleukin-6 agents (tocilizumab) and T-cell regulatory agents (abatacept) have been shown to be safe and effective in childhood patients. Recent studies reported sustained reduction in joint damage with even complete clinical improvement in paediatric patients, compared to previous data.

Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single‐center experience

“…In general, joint involvement in JIA patients depends on the disease subtype and age of patients. 38 Our observations lead us to consider that patients older than 10 have milder clinical courses.…”

Juvenile idiopathic arthritis – diagnostic and therapeutic procedures

“…W postaci wielostawowej MIZS czynnikami złej prognozy są zmiany zapalne stawów biodrowych, kręgosłupa szyjnego, obecność we krwi RF oraz przeciwciał anty-CCP, a także radiologicznie zdefiniowane dysfunkcje stawów w postaci zwężenia szpar stawowych i nadżerek kostnych. Natomiast, w postaci nielicznostawowej MIZS, do grupy omawianych czynników zalicza się zapalenie stawu biodrowego, kręgosłupa szyjnego, stawu skokowego lub nadgarstkowego, utrzymujące się podwyższone wartości laboratoryjnych wskaźników ostrej fazy, a w badaniu radiologicznymobecność zwężenia szpar stawowych czy nadżerek kostnych [20][21][22][23].…”

“…Istnieje możliwość zastosowania NLPZ w postaci monoterapii, jednakże najczęściej podawane są w połączeniu z innymi lekami, zalecanymi w terapii MIZS. Na rycinie 5 przedstawiono zestawienie najczęściej stosowanych NLPZ wraz z dawkowaniem zależnym od wieku pacjenta [23,27,28].…”

“…Leki należące do omawianej grupy charakteryzują się długim okresem półtrwania, jednak najlepsze efekty terapeutyczne uzyskuje się przy długotrwałym stosowaniu tej grupy farmaceutyków. Leki biologiczne, nazywane także modyfikatorami odpowiedzi immunologicznej wraz z zalecanymi dawkami terapeutycznymi przedstawiono w tabeli 4 [23,29,[37][38][39].…”

LACC1 Gene Defects in Familial Form of Juvenile Arthritis

“…Juvenile idiopathic arthritis [JIA; Mendelian Inheritance in Man (MIM) 604302] is the most common chronic childhood arthritis, characterized by chronic articular findings of unknown origin, with heterogeneity in disease course and systemic involvement 1,2 . Epidemiologic studies based on different diagnostic criteria showed varying prevalence from 0.07 to 4.01 per 1000 children across populations, an increased risk for European descendants, and different subtype distributions among ethnic groups 3,4 .…”