Summary
Between the years 1952 and 1974, 1293 children aged from 1–14 years with the adult type of rheumatoid arthritis and Still's disease were admitted, of whom 793 or 61.2% received oral corticosteroids, mostly in the form of continuous therapy.
In all children with Still's syndrome (476 cases, of whom 84.4% received corticosteroid therapy), as well as in 75% of the children with rheumatoid arthritis (817 cases, 47.1% under corticosteroid treatment) the therapy had already been initiated by the referring institutions. The mortality and morbidity of corticosteroid treated children is compared with the results from the precortisosteroid era. The influence upon rheumatic activity as well as on joint pathology was compared in groups of patients with rheumatoid arthritis with and without steroid therapy. Corticosteroid therapy led to a significant reduction in the early mortality from myo- and pericarditis in Still's syndrome. On the other hand, the late mortality of 5% was encumbered with a high incidence of direct sequelae of longterm corticosteroid therapy and secondary diseases, especially amyloidosis. Furthermore, more than half of the children on longterm treatment had severe irreversible, and partially fatal lesions. The results of the present investigation strongly suggest that the indications for and the manner of using corticosteroids in treating rheumatoid arthritis and Still's syndrome ought to be revised.
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References
Ansell, B. M., Bywaters, E. G. L.: Rheumatoid arthritis (Still's disease). Pediat. Clin. N. Amer. 10, 921 (1963)
Ansell, B. M.: Long term follow-up of juvenile chronic polyarthritis. 16. Tagung der Deutschen Gesellschaft für Rheumatologie 1974
Edström, G., Gedda, P. O.: Clinic and prognosis of rheumatoid arthritis in children. Acta rheum. scand. 3, 129 (1957)
Kölle, G.: Klinisches Bild und Verlauf der juvenilen rheumatoiden Arthritis und des Still-Syndroms. Statistische Erhebungen bei 720 Kindern. Mschr. Kinderheilk. 118, 488 (1970)
Kölle, G.: Die juvenile rheumatoide Arthritis und das Still-Syndrom. (Eine klinische und katamnestische Dokumentation.) Rheumaforum, Heft IV. Karlsruhe: Braun 1975
Kötgen, U., Callensee, W.: Statistische Untersuchungen zum kindlichen Rheumatismus. Darmstadt: Steinkopf 1959
Leichtentritt, B.: Rheumatische Erkrankungen im Kindesalter. In: Dietrich, E., Hirsch, M., Rheuma-Jahrbuch 1930/31, 1
Müller, G.: Über die chronischen, nicht rheumatischen Polyarthritiden des Kindesalters. Inaug.-Diss., München 1942
Sänger, L.: Klinische Verlaufsuntersuchung der Wachstumsretardierung von Kindern mit rheumatoider Arthritis und Still-Syndrom. Mschr. Kinderheilk. 122, 331 (1974)
Schwenk, D.: Linsenveränderungen bei rheumatischen Kindern bei langfristiger Corticosteroidtherapie. Z. Rheumaforsch. 26, 153 (1967)
Stoeber, E.: Die ACTH- und Cortisonanwendung beim rheumatischen Formenkreis. Mschr. Kinderheilk. 108, 194 (1960)
Stoeber, E.: Chronische Polyarthritis (rheumatoide Arthritis) einschließlich Morbus Still. In: Opitz, H., Schmid, F., Handbuch der Kinderheilkunde, Vol. III, p. 204. Berlin-Heidelberg-New York: Springer 1966
Stoeber, E., Kölle, G.: Die Nebennierenhormonbehandlung der rheumatoiden Arthritis und ihrer Syndrome. Eine Sechs-Jahresübersicht. Z. Rheumaforsch. 19, 231 (1960)
Steinbrocker, D., Traeger, C. K., Battermann, R.: Therapeutic criteria in rheumatoid arthritis. J. Amer. med. Ass. 140, 659 (1949)
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Nomenclature. Rheumatoid arthritis or chronic progredient polyarthritis “sensu strictiore” in children is similar to the adult, seronegative type of the disease. Oligo- and monarthritis are more often combined with iridocyclitis than in adult rheumatoid arthritis.
Complete Still's disease—acute onset with high, sometimes septic fever at the beginning and/or during the course of the disease. Extraarticular manifestations are predominant such as myopericarditis, rheumatic rash, hepato- and splenomegaly, lymphadenitis, leucocytosis, severe anaemia and rheumatic nodules.
Incomplete Still's disease—the initial acute and febrile course of the disease is present but less severe and systematic extraarticular, visceral manifestations are partly present.
The term “complete or incomplete Still's syndrome” should express the possibly near, but not warranted unity of the above classified three manifestations of the rheumatic disease in childhood. The term juvenile rheumatoid arthritis or juvenile chronic polyarthritis includes all three variations of the disease in childhood without the necessary differentiation, and is therefore not exact enough when comparing statistics, since the prognosis and therapy of the three types are different.
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Stoeber, E. Corticosteroid treatment of juvenile chronic polyarthritis over 22 years. Eur J Pediatr 121, 141–147 (1976). https://doi.org/10.1007/BF00443068
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DOI: https://doi.org/10.1007/BF00443068