Clinical presentation of juvenile idiopathic arthritis in Bangladesh: experience from a tertiary hospital

Abstract

Objective: To present our experience of juvenile idiopathic arthritis (JIA) patients in terms of clinical presentation and to observe if there is any difference in clinical presentation of our children from that in the Western world. Methodology: A cross‐sectional observational study was carried out in the paediatric rheumatology follow‐up clinic run by the Department of Child Health, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the study period of January 2004 to April 2007. A total of 132 patients fulfilling International League against Rheumatism classification criteria were enrolled in the study. Data were collected in a questionnaire containing clinical history, physical findings, relevant investigations and ophthalmologic findings. Results: Among the 132 cases 89 were male and 43 were female, M:F ratio being approximately 2:1. Age range of the patients was 1.5 years to 15 years. Maximum number of patients presented in the age group from 7–8 years (12.10%) followed by 10–11 years (11.36%). Duration of illness was more than 12 months in the majority. Polyarticular rheumatoid factor‐negative patients were most frequent (41.70%), followed by persistent oligoarthritis (23.50%). The majority of the patients (51.52%) were diagnosed with rheumatic fever before they reported to us. Conclusion: Late diagnosis with long duration of disease and deformities were common. Wrong diagnosis and wrong treatment was also very common. Clinical presentation of our cases differed from Western JIA cases mainly is terms of sex distribution, subtypes and late presentation.

Efficacy of Tocilizumab in the Treatment of Systemic Onset Juvenile Idiopathic Arthritis

“…Previous studies from our country also reported long duration and very high disability and severity of JIA patients at presentation. 21,22 Moderate response was found as 93.3% at 12 weeks and 92.3% at 24 weeks among cases and 71.5% and 85.7% among controls at 12 weeks and 24 weeks respectively.…”

Prevalence and clinical pattern of juvenile idiopathic arthritis in a semi‐urban area of Bangladesh

“…The data from Europe and North America suggested that girls outnumber boys in JIA . Very few data are available from tertiary level hospitals in Bangladesh, where it was found that 47% of JIA patients had polyarticular and 34.1% had oligoarticular arthritis, and the girl : boy ratio was 1 : 2 . These study findings were different from those of Western countries.…”

“…However; few reports are available on JIA from developing countries. Very scanty reports on JIA are available in Bangladesh from a tertiary level hospital regarding clinical aspects of the disease …”

2.19 Pediatric rheumatology

“…There is an association of low BMD with duration of disease (3). In Bangladesh it is reported that majority of JIA cases are diagnosed after a long duration (4).…”

“…These features, rather than joint count, represent a more pertinent category, comprising ANA positive oligoarthritis, ANA positive RF negative polyarthritis and ANA positive psoriatic arthritis [2]. Second, the use of anti-CCP allowed the identification of a subgroup of polyarthritis associated with erosive disease and poor radiographic outcome [4]. Third, the use of advanced imaging like ultrasound and MRI showed superiority to clinical examination in the number of affected joints, making a classification based on the joint count somehow inadequate [5].…”