Juvenile Idiopathic Arthritis: Diagnosis and Treatment

Giancane, Gabriella; Consolaro, Alessandro; Lanni, Stefano; Davì, Sergio; Schiappapietra, Benedetta; Ravelli, Angelo

doi:10.1007/s40744-016-0040-4

Cited by 197 publications

(232 citation statements)

References 124 publications

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“…Laboratory findings show leukocytosis with neutrophilia, thrombocytosis, elevated erythrocyte sedimentation rate (ESR), and elevated C-reactive protein. Microcytic anemia is also a common lab finding [7]. In patients with systemic JIA, the presence of pancytopenia, hypofibrinogenemia, hyperferritinemia, hypertriglyceridemia, and increased serum transaminase suggest the occurrence of macrophage activation syndrome (MAS) (Table 2) [11].…”

Section: Subtypes Of Jiamentioning

confidence: 99%

“…RF-negative polyarthritis accounts for 17% of children with JIA [1,7]. RF-negative polyarthritis is defined as an arthritis affecting five or more joints during the first 6 months of disease and an absence of immunoglobulin (Ig)M RF.…”

Section: Subtypes Of Jiamentioning

confidence: 99%

“…RF-negative polyarthritis is defined as an arthritis affecting five or more joints during the first 6 months of disease and an absence of immunoglobulin (Ig)M RF. This is a heterogeneous subtype that may manifest with at least three distinct subsets [1,2,7]. The first subset is a form that resembles early-onset oligoarthritis, but differs in the number of joints affected in the first 6 months of disease.…”

Section: Subtypes Of Jiamentioning

confidence: 99%

“…The incidence has varied from 2 to 23 per 100,000 and the prevalence rates have varied from 4 to 400 per 100,000 children [6]. The International League of Associations for Rheumatology classified JIA into seven subtypes based on distinct clinical and laboratory findings: systemic, oligoarticular, polyarticular with and without rheumatoid factor, enthesitis-related arthritis (ERA), psoriatic arthritis, and undifferentiated arthritis (Table 1) [1,4,7]. A remarkable different rate in the frequency of JIA has been noticed in different geographical areas and ethnic groups.…”

Section: Introductionmentioning

confidence: 99%

“…A remarkable different rate in the frequency of JIA has been noticed in different geographical areas and ethnic groups. In Western countries, oligoarthritis is the most common subtype, while polyarthritis predominates in Costa Rica, India, and New Zealand [1,7]. In Asia, systemic arthritis accounts for a greater proportion of childhood arthritis [8].…”

Section: Introductionmentioning

confidence: 99%

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Differential Diagnosis of Juvenile Idiopathic Arthritis

Job

Cho

2017

J Rheum Dis

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Juvenile idiopathic arthritis (JIA) is a broad spectrum of disease defined by the presence of arthritis of unknown etiology, lasting more than six weeks duration, and occurring in children less than 16 years of age. JIA encompasses several disease categories, each with distinct clinical manifestations, laboratory findings, genetic backgrounds, and pathogenesis. JIA is classified into seven subtypes by the International League of Associations for Rheumatology: systemic, oligoarticular, polyarticular with and without rheumatoid factor, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Diagnosis of the precise subtype is an important requirement for management and research. JIA is a common chronic rheumatic disease in children and is an important cause of acute and chronic disability. Arthritis or arthritis-like symptoms may be present in many other conditions. Therefore, it is important to consider differential diagnoses for JIA that include infections, other connective tissue diseases, and malignancies. Leukemia and septic arthritis are the most important diseases that can be mistaken for JIA. The aim of this review is to provide a summary of the subtypes and differential diagnoses of JIA. (J Rheum Dis 2017;24:131-137)

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Section: Subtypes Of Jiamentioning

confidence: 99%

Section: Subtypes Of Jiamentioning

confidence: 99%

Section: Subtypes Of Jiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differential Diagnosis of Juvenile Idiopathic Arthritis

Job

Cho

2017

J Rheum Dis

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Safety and Effectiveness of Adalimumab in Patients With Polyarticular Course of Juvenile Idiopathic Arthritis: STRIVE Registry Seven‐Year Interim Results

Brunner

Nanda

Toth

et al. 2020

Arthritis Care & Research

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Objective To evaluate safety and effectiveness of adalimumab (ADA) in polyarticular‐course juvenile idiopathic arthritis (JIA) in the STRIVE registry. Methods STRIVE enrolled patients with polyarticular‐course JIA into 2 arms based on treatment with methotrexate (MTX) alone or ADA with/without MTX (ADA ± MTX). Adverse events (AEs) per 100 patient‐years of observation time were analyzed by registry arm. Patients who entered the registry within 4 weeks of starting MTX or ADA ± MTX, defined as new users, were evaluated for change in disease activity assessed by the 27‐joint Juvenile Arthritis Disease Activity Score with the C‐reactive protein level (JADAS‐27CRP). Results At the 7‐year cutoff date (June 1, 2016), data from 838 patients were available (MTX arm n = 301, ADA ± MTX arm n = 537). The most common AEs were nausea (10.3%), sinusitis (4.7%), and vomiting (4.3%) in the MTX arm and arthritis (3.9%), upper respiratory tract infection (3.5%), sinusitis, tonsillitis, and injection site pain (3.0% each) in the ADA ± MTX arm. Rates of serious infection were 1.5 events/100 patient‐years in the MTX arm and 2.0 events/100 patient‐years in the ADA ± MTX arm. AE and serious AE rates were similar in patients receiving ADA with versus without MTX. No deaths or malignancies were reported. New users in the ADA ± MTX arm showed a trend toward lower mean JADAS‐27CRP compared with new users in the MTX arm in the first year of STRIVE. Conclusion The STRIVE registry 7‐year interim results support the idea that ADA ± MTX is well tolerated by most children. Registry median ADA exposure was 2.47 (interquartile range 1.0–3.6) years, with 42% of patients continuing ADA at the 7‐year cutoff date.

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Functional Ability and Health‐Related Quality of Life in Randomized Controlled Trials of Tocilizumab in Patients With Juvenile Idiopathic Arthritis

Brunner

Chen

Bovis

et al. 2021

Arthritis Care & Research

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Objective To evaluate changes in health‐related quality of life (HRQoL) and disability in children with systemic juvenile idiopathic arthritis (JIA) or polyarticular JIA treated with tocilizumab. Methods Secondary analyses of two double‐blind, placebo‐controlled trials of intravenous tocilizumab in children with active systemic JIA or polyarticular JIA were conducted. Patient‐reported outcomes of disability (Childhood Health Assessment Questionnaire [C‐HAQ]), HRQoL (Child Health Questionnaire Parent Form 50 [CHQ‐P50], health concepts, physical summary score [CHQ‐P50‐PhS], psychosocial summary score [CHQ‐P50‐PsS]), pain, and well‐being (100‐mm visual analog scale [VAS]) were measured at weeks 0 and 12 for systemic JIA, weeks 16 and 40 for polyarticular JIA, and week 104 for both JIA subgroups. Results The trial included 112 patients with systemic JIA and 188 patients with polyarticular JIA. In patients with polyarticular JIA, the mean ± SD C‐HAQ score decreased from 1.39 ± 0.74 at baseline to 0.67 ± 0.65 at week 16 (P < 0.001). In patients with systemic JIA, the mean ± SD CHQ‐P50‐PhS improved more with tocilizumab therapy than with placebo at week 12 (7.3 ± 10.2 versus 2.4 ± 10.6) (P < 0.05). Almost all mean CHQ‐P50 health concept scores, CHQ‐P50‐PsS, and CHQ‐P50‐PhS improved (P ≤ 0.002) by week 104 for patients with systemic JIA. Patients with polyarticular JIA and patients with systemic JIA showed significant reductions in disability (mean ± SD C‐HAQ scores of −1.09 ± 0.71 and −1.17 ± 0.80, respectively), improvements in well‐being (mean ± SD well‐being VAS scores of −43.76 ± 26.61 and −51.53 ± 23.57, respectively), and decreases in pain (mean ± SD pain VAS scores of −41.56 ± 31.06 and −51.26 ± 26.79, respectively) (P < 0.001); in patients with polyarticular JIA and patients with systemic JIA who were treated with tocilizumab, 92.9% of polyarticular JIA patients and 96.8% of systemic JIA patients reported no more than minimal pain (a score of ≤35 mm on the VAS) at week 104. Conclusion Tocilizumab treatment was associated with significantly reduced disability and pain and improved HRQoL in patients with systemic JIA and polyarticular JIA.

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Juvenile Idiopathic Arthritis: Diagnosis and Treatment

Cited by 197 publications

References 124 publications

Differential Diagnosis of Juvenile Idiopathic Arthritis

Differential Diagnosis of Juvenile Idiopathic Arthritis

Safety and Effectiveness of Adalimumab in Patients With Polyarticular Course of Juvenile Idiopathic Arthritis: STRIVE Registry Seven‐Year Interim Results

Functional Ability and Health‐Related Quality of Life in Randomized Controlled Trials of Tocilizumab in Patients With Juvenile Idiopathic Arthritis

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