Corticosteroid treatment of juvenile chronic polyarthritis over 22 years

Abstract

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.

What is low-dose corticosteroid therapy in juvenile idiopathic arthritis?

“…For the systemic, long-term treatment of juvenile idiopathic arthritis (JIA), corticosteroids are only being used in a rather restricted manner because of their various adverse effects, including in part irreversible growth suppression (5,6,8,10). While higher dosages are mandatory in critical situations, like severe myocarditis, only a low-dose regimen is acceptable for long-term anti-arthritic therapy.…”