Abstract
Juvenile arthritis implies an onset of disease under 16 years with arthritis persisting in one or more joints for at least six weeks, and with the active exclusion of well defined illnesses, such as systemic lupus erythematosus. Prognosis implies the ability to predict outcome. Its accuracy depends on many factors with early recognition and appropriate care being important. However, response to treatment may be variable. In general, those with involvement of a few joints do better than those with systemic disease or seropositive juvenile rheumatoid arthritis both with regard to persistence of disease activity and complications. These include not just joint deformities, but osteoporosis, amyloidosis, alterations in growth with overall failure and local anomalies, chronic iridocyclitis and psychosocial problems. More aggressive therapy was only introduced in the 1990s, so it is important that multicentre studies are properly assessed in the context of the suggested International diagnostic criteria.
One hundred years ago, George Fredric Still drew attention to the systemic form of the disease as distinct from pure polyarthritis [1], but it was only in the 1970s, as followup proceeded, that the separate identity of variants became clinically evident [2].
At the Park City meeting [3] and at the EULAR meeting in 1977 [4] when three subgroups (notably systemic, polyarthritis and pauci-articular onset) were defined, that sub-classification became regularly used. However, since there were no absolute diagnostic tests there had to be exclusions. At that time the most common medications were aspirin and corticosteroids, although a few patients received gold or penicillamine. In their large group Wallace and Levinson (1990) [5] found that at the 10 year follow-up between 31% and 55% still had active disease. Girls appeared to have a five-fold greater risk for persistent activity than boys; disease duration was probably the most important factor influencing disease activity at follow-up as suggested previously [6].
It was not until the 1990s that the more aggressive therapy in the form of methotrexate—which Giannini had shown to be effective when given in appropriate dosage
At the ILAR Meeting in 1993 an international task force was set up under the chairmanship of Dr. C. Fink [11] to develop a classification for the idiopathic arthritides in children, defining childhood as up to 16 years of age. Active exclusion of well-recognised disorders such as rheumatic fever or systemic lupus erythematosus, still had to be made. The first proposed types, which are mutually exclusive, are shown in Table 1. A more recent meeting in Durban under the chairmanship of Dr. R. Petty is yet to be published, but considerable advances have been made, particularly in the definition of subgroups.
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References
G.F. Still. On a chronic form of chronic joint disease in children. Medico-Transacter 80: 47–59 (1897).
B.M. Ansell, P.H.N. Wood. Progress in juvenile polyarthritis. Clin Rheum Dis 2: 297–412 (1976).
Proceedings of the First ARA Conference on the Rheumatic Diseases of Childhood, Park City, Utah. Arthritis Rheum, 20 (Suppl 2) (1977).
EULAR 1977. The Care of Rheumatic Children, (ed) E. Munthe. EULAR Publishing, Basle.
C.A. Wallace, J.C. Levinson. Juvenile rheumatoid arthritis: Outcome and Treatment for the 1990s. Rheum Dis Clin N Amer 17: 891–905 (1991)
B.M. Ansell, E.G.L. Bywaters. Progress in Still’s disease. Bull Rheum Dis 9: 189 (1959).
E.H. Giannini, E.J. Brewer, N. Kuzmina, A. Sharkon, Maximov, I.Varonstov et al. Methotrexate in resistant juvenile chronic arthritis: Results of the USA, USSR double blind placebo controlled trial. New Eng J Med 326: 1043–1049(1992)
B.M. Ansell, M.A. Hall, J.K. Loftus, P. Woo, V. Neumann, J.A. Sills, D. Swinson, J. Insley, R. Amos, W. Dodds. A multicentre pilot study of sulphasalazine in juvenile chronic arthritis. Clin Exp Rheumatol 9: 201–203 (1991)
A. Earley, C. Cuttica, C. McCoullough, B.M. Ansell. Triamcinolone into the knee joint in juvenile chronic arthritis. Clin Exp Rheumatol 6: 153–155 (1988)
R.C. Allen, K.R. Gross, R.M. Laxer, P.N. Malesn, R.D. Beauchamp, R. Petty. Intra-articular triamcinolone hexatonide in the management of chronic arthritis in children. Arth Rheum 29: 997–1001. (1996)
C. Fink and the Task Force. Proposal for the development of classicification criteria for Idiopathic Arthritides in Childhood. J Rheumatol 22: 1566–1569 (1995)
J.L. Stephen, J. Zeller, P. Hubert, C. Herbelin. J.M. Dayer, A.M. Prieur. Macrophage activation syndrome and rheumatic disease in childhood: a report of 4 new cases. Clin Exp Rheumatol 11: 451–456 (1993)
A. Ravelli, F. DeBenedetti, S. Viola, A. Martin. Macrophage activation syndrome in systemic juvenile rheumatoid arthritis successfully treated with Cyclosporin. J Pediatr 128: 275–278 (1996)
H. Svantesson, A. Akesson, K. Eberhardt, R. Ellborgh. Prognosis in juvenile rheumatoid arthritis with systemic onset. Scand J Rheumatol 12: 139–144 (1983).
J. David, O. Vouyiouka, B.M. Ansell, A. Hall, P. Woo. Amyloidosis in juvenile chronic arthritis: a morbidity and mortality study. Clin Exp Rheumatol 11: 85–90 (1993).
P.N. Hawkins, M.J. Myers, A.A. Eperlos, D. Caspi, M.B. Pepys. Specific localisation and imaging of amyloid deposits in vivo using 123I-labelled serum amyloid P component. J Exp Med 167: 903–913
P. Woo, H. Wilkes, T. Southwood, A.M Prieur, et al. Low dose methotrexate is effective in extended oligoarticular arthritis but not in systemic arthritis in children. Arthritis Rheum, Abstract 97. 1997
J. Loftus, R. Allen, R. Hesp, J. David, D.M. Reid, D.J. Wright, J.R. Geen. J. Reeve, B.M. Ansell, P. Woo. Randomised double-blind trial of deflazacort versus prednisone in juvenile chronic (or rheumatoid) arthritis: a relatively bone sparing effect of deflazacort. Br J Rheumatol. 32(Supp 2) 31–38 (1993).
L. Harel, L. Wague-Weiner, A.K. Posnaski. C.H. Spencer, E. Ekoo and D.B. Magiluy. Effects of methotrexate on radiological progression in juvenile rheumatoid arthritis. Arthritis Rheum 36: 1370–1374 (1993).
B.M. Ansell. Juvenile chronic arthritis with persistently positive tests for rheumatoid factor. Annales de Pediatrie. 30: 545–550(1983).
A.M. Rosenberg. Uveitis associated with juvenile rheumatoid arthritis. Semin Arthritis Rheum 16: 158–173 (1987).
E. Candell Chalom, D.P. Goldsmith, M.A. Koehler, B. Bittar, C.D. Rose, B.E. Ostrov, G.F. Keenan. Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J. Rheumatol 24: 2035–2037(1997).
F. Halle, A.M. Prieur. Evaluation of methotrexate in the treatment of juvenile arthritis according to the sub type. Clin Exp Rheumatol 9: 297–302 (1991)
A.M. Rosenber, R.E. Petty. A syndrome of sero-negative enthesopathy and arthropathy in children. Arthritis and Rheum 25: 1041–1047 (1982)
R. Brugos-Vargas, C. Pacheco-Tena, J. Vasquez-Mellado. Juvenile onset spondyloarthropathies. Rheum Dis Clin N Am 23: 569–598. (1997)
A. Shore, B.M. Ansell. Juvenile psoriatic arthritis: an analysis of 60 patients. J. Pediatr 4: 529–535 (1982)
T. Southwood, R. Petty. Psoriatic arthritis in childhood. Arthritis Rheum 32: 1007–1013 (1989).
V. Pistoia, A. Buoncompagni, R. Scribancs, L. Fasce, G. Alpigiani, G. Cordone, M. Ferrarini, C. Borrone, G. Cottafave. Cyclosporin A in the treatment of juvenile chronic arthritis and childhood polymyositis-der-matomyositis. Results of a preliminary study. Clin Exp Rheumatol 11, 203–308 (1993)
U.M. Davies, M. Rooney, J. Reeve, M.A. Preece, B.M. Ansell, P. Woo. Treatment of growth retardation in juvenile chronic arthritis with recombinant human growth hormone. J Rheumatol 21: 153–158 (1994).
P.H. Pepmueller, J.T. Cassidy, S.H. Alan, L.S. Hillman. Bone mineralisation and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum 39: 746–757 (1996).
M.A. Muzaller, R. Schneider, R.J. Cameron, E.D. Silverman, R.M. Laxer. Accelerated nodulosis during methotrexate therapy for juvenile rheumatoid arthritis. J Pediatr 128: 698–700 (1996).
S. Padeh, N. Sharon, G. Gchiby, G. Rechavi, J.H. Passwell. Hodgkin’s lymphoma in systemic onste juvenile rheumatoid arthritis after treatment with low-dose methrotrexate. J. Rheumatol 24: 3025–3027 (1997).
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Ansell, B.M. (1999). Prognosis in Juvenile Arthritis. In: Mallia, C., Uitto, J. (eds) Rheumaderm. Advances in Experimental Medicine and Biology, vol 455. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-4857-7_5
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