A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis

Objective. To characterize local bone geometry, density, and strength, using peripheral quantitative computed tomography (pQCT), compared with general bone characteristics as measured using dual x-ray absorptiometry (DXA), and to assess their relationship to disease-related factors in children with juvenile rheumatoid arthritis (JRA).Methods. Forty-eight children ages 4-18 years with JRA (17 pauciarticular, 23 polyarticular, 8 systemic) were compared with age-matched healthy controls (n ‫؍‬ 266). Measurements included cortical and trabecular bone geometry, density, and strength at the distal and midshaft tibia determined by pQCT, and whole-body, lumbar spine, and femoral neck measurements by DXA.Results. Methotrexate (MTX) was prescribed to 23 of 48 patients (47.9%) and glucocorticoids and MTX were prescribed to 15 of 48 patients (31.3%), with the greatest use in children with systemic JRA. All JRA patients had decreased tibia trabecular bone density, cortical bone size and strength, and muscle mass. Children with systemic JRA had lower femoral neck densities. Systemic JRA was associated with a shorter, less mineralized skeleton, while a narrower, less mineralized skeleton was observed in polyarticular JRA. The tibia diaphysis was narrower with decreased muscle mass, but normal, size-adjusted bone mineral in all subtypes indicated a localized effect of JRA on bone. Patients exposed to glucocorticoids and MTX or to glucocorticoids or MTX alone had greatly reduced trabecular density, cortical bone geometry properties, and bone mineral content, muscle mass, and bone strength.Conclusion. Children with JRA have decreased skeletal size, muscle mass, trabecular bone density, cortical bone geometry, and strength. Not surprisingly, these bone abnormalities are more pronounced in children with greater disease severity.

Section: Methodsmentioning

confidence: 99%

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Felin¹,

Prahalad²,

Askew³

et al. 2007

“…Patients were selected from a population of 225 patients with juvenile-onset SPA or JRA who first attended the Pediatric Rheumatology Clinic of the Mexico City General Hospital between 1980 and 1985. Selection criteria included 1) onset of symptoms before the age of 16, 2) disease duration of -4% years at the first rheumatology clinic visit, 3) followup of at least 10 years from onset, and 4) a diagnosis of definite AS according to the New York criteria (28) or of systemic, IgM-RF-positive or negative polyarticular, or type I pauciarticular (i.e., with ANA and/or chronic iridocyclitis) JRA according to the American College of Rheumatology criteria (22,29,30) during such followup. The purpose of selecting patients with <2V2 years of disease at first rheumatology clinic presentation was to reduce the risk of obtaining inaccurate data on disease onset and to assess at least 7.5 years of the 10-year period since the first symptoms occurred.…”

Section: Methodsmentioning

confidence: 99%

The early clinical recognition of juvenile‐onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis

Burgos‐Vargas

Vázquez‐Mellado

1995

116

Objective. To determine which early clinical data differentiate juvenile-onset ankylosing spondylitis (AS) from juvenile rheumatoid arthritis (JRA).Methods. Medical records of 35 patients with juvenile-onset AS and 75 with JRA (excluding type I1 pauciarticular JRA), all of whom had disease onset at age 516 years, disease duration of 52% years at the initial visit to the rheumatology clinic, and followup of 2 10 years, were analyzed retrospectively with regard to features of disease found 6 months, 12 months, and 10 years after onset.Results. At 6 months, various features appeared more frequently in the juvenile-onset AS group than in the JRA group, i.e., pauciarthritis (54.3% versus 30.7%; P = 0.03, odds ratio [OR] = 2.7), enthesopathy (82.9% versus 0%; P < 0.0001, OR = 321.4), tarsal disease (71.4% versus 1.3%; P < 0.0001, OR = 185.0), and lumbar/sacroiliac symptoms (11.4% versus 0%; P = 0.02, OR = 11.9). At 12 months, the features found more frequently among juvenile-onset AS patients than JRA patients were enthesopathy (88.6% versus 4.0%; P < 0.0001, OR = 186.0), tarsal disease (85.7% versus 10.7%; P < 0.0001, OR = 50.3), and knee disease (100.0% versus 82.7%; P = 0.04, OR = 8.0). Involvement of the upper extremities (especially the hands) was found in significantly fewer juvenile-onset AS patients compared with the JRA group. Definite involvement of the spine and sacroiliitis in juvenile-onset AS occurred after a mean & SD of 7.3 f 2.0 years.Conclusion. Regardless of axial disease, enthes-

“…Criteria for study eligibility were as follows: age Ն4 years but Ͻ18 years, a diagnosis of JRA (16), suboptimal response to MTX after Ն3 months of treatment, Ն5 active joints, and no active systemic symptoms. Exclusion criteria included active uveitis, serious infection including tuberculosis, malignancy, or prior treatment with any TNF inhibitor.…”

Section: Patientsmentioning

confidence: 99%

A randomized, placebo‐controlled trial of infliximab plus methotrexate for the treatment of polyarticular‐course juvenile rheumatoid arthritis

Ruperto

Lovell

Cuttica

et al. 2007

370

224

Objective. To evaluate the safety and efficacy of infliximab in the treatment of juvenile rheumatoid arthritis (JRA).Methods. This was an international, multicenter, randomized, placebo-controlled, double-blind study. One hundred twenty-two children with persistent polyarticular JRA despite prior methotrexate (MTX) therapy were randomized to receive infliximab or placebo ClinicalTrials.gov identifier: NCT00036374.