Update on juvenile rheumatoid arthritis

Research output: Contribution to journalArticle

Abstract

JRA is diagnosed when a child 16 years or less has arthritis in one or more joints for at least six consecutive weeks and other causes of arthritis are excluded. There is predominantly large joint involvement with frequent cervical spine involvement and children may present with contractures and atrophy of muscles. Subtypes of the disease are defined by clinical features in the first six months. Children with JRA may also have chronic uveitis, a positive ANA and only about 5-10% have a positive rheumatoid factor JRA is really at least five diseases lumped together under this heading. Systemic- onset JRA (15-20% of patients) presents with fever and rash, hepatosplenomegaly, lymphadenopathy, anemia, leukocytosis and thrombocytosis initially. Arthritis appears within a few months and systemic manifestations wane. Pauciarticular JRA (about 50% of patients, 4 joints or less initially) is the mildest form of JRA. It may be subtyped into early onset (young girls, often with chronic iritis), and late onset (boys, often with acute iritis and spondyloarthropathy). Polyarticular JRA (5 or more joints) can cause more permanent disability. It may be subtyped into rheumatoid factor negative and rheumatoid factor positive which has a much worse prognosis. First line therapy for JRA uses NSAIDs. With conscious sedation interarticular injection of corticosteroids may provide control without systemic medication. For second line therapy, methotrexate in low doses is very useful and has replaced other drugs, with good response in about 85% of patients. Third Line Therapy involves tumor necrosis factor receptor and has been shown to be effective in adults and is under study in children.

Original languageEnglish (US)
Pages (from-to)113-122
Number of pages10
JournalChildren's Hospital Quarterly
Volume10
Issue number3
StatePublished - 1998
Externally publishedYes

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Juvenile Arthritis
Rheumatoid Factor
Joints
Iritis
Arthritis
Conscious Sedation
Spondylarthropathies
Thrombocytosis
Muscular Atrophy
Tumor Necrosis Factor Receptors
Uveitis
Leukocytosis
Contracture
Non-Steroidal Anti-Inflammatory Agents
Exanthema
Methotrexate
Anemia
Adrenal Cortex Hormones
Spine
Fever

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Update on juvenile rheumatoid arthritis. / Ilowite, Norman Todd.

In: Children's Hospital Quarterly, Vol. 10, No. 3, 1998, p. 113-122.

Research output: Contribution to journalArticle

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