Hepatic involvement in juvenile rheumatoid arthritis

During a 10-year period, chronic iridocyclitis occurred in 8 of 100 patients with juvenile rheumatoid arthritis. It was an initial manifestation in 1 patient and occurred 1-8 years after onset in 7. Three patients had a recurrence. Children at greatest risk have the least arthritis. For early detection of the frequently insidious and recurrent iridocyclitis, regular slit lamp examinations are recommended to help prevent blindness due to band keratopathy and/or cataract.

“…Antinuclear antibodies were not detected in the sera of our patients, contrasting with a recent report (9) in which antibodies were present in 5 of 8 JRA patients with iridocycli tis.…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

Chronic iridocyclitis in juvenile rheumatoid arthritis

Calabro

Parrino

Atchoo

et al. 1970

“…Almost all patients were being treated with NSAIDs at the time of their biopsy. Similar nonspecific findings were found in 8 JRA patients with NSAID-related hepatotoxicity (37) and in patients with systemic-onset JRA (36). However, portal fibrosis was not found in non-MTXtreated JRA patients (36,37).…”

Section: Discussionsupporting

confidence: 76%

The long‐term effect of methotrexate therapy on the liver in patients with juvenile rheumatoid arthritis

Hashkes

Balistreri

Bove

et al. 1997

Objective. To determine if the long‐term use of methotrexate (MTX) in juvenile rheumatoid arthritis (JRA) is associated with the development of significant liver fibrosis, and to describe the presence of risk factors for liver fibrosis in patients with JRA. Methods. Needle biopsies of the liver were performed on a cross‐section cohort of 14 patients with JRA who had received a total cumulative dose of MTX that was either >3,000 mg or >4,000 mg/1.73 m2 of body surface area. Biopsy samples were independently graded according to the Roenigk Classification Scale by 2 pathologists. The presence of risk factors for MTX hepatotoxicity, especially biochemical abnormalities reflective of liver injury and alcohol consumption, were assessed. Results. Thirteen biopsy samples (93%) were classified as grade I, and 1 (7%) as grade II; none demonstrated significant fibrosis. However, histologic abnormalities were found in 13 biopsy samples (93%). Only 2 patients (14%) consumed more than 1 alcoholic drink per month. Thirteen patients (93%) had biochemical abnormalities while being treated with MTX, but only 5 patients (36%) had at least 1 determination in which the aspartate or alanine aminotransferase elevation was >3 times the upper limit of normal. Conclusion. Long‐term use of MTX for JRA does not appear to be associated with the development of significant liver fibrosis. Although nearly all patients had minor histologic changes, no significant clinical consequences were apparent. A prospective study of a larger population will more accurately define the incidence of MTX‐related liver fibrosis and appropriate monitoring guidelines in JRA.

“…The hepatic involvement reported in 5 cases of JRA by Schaller et al (17) appears unlike that observed in conjunction with salicylate therapy. These patients all had massive hepatomegaly and profound systemic manifestations of JRA.…”

Section: Discussionmentioning

confidence: 77%

“…These biopsy findings are obviously relatively nonspecific. Histologic examination of patients with JRA and hepatomegaly by Schaller et a1 (17) also revealed periportal infiltration with chronic inflammatory cells, although parenchymal necroses were not observed.…”

Section: Discussionmentioning

confidence: 89%

Salicylate hepatotoxicity in patients with juvenile rheumatoid arthritis

Rich

Johnson

1973

108

Salicylates were administered to 6 patients with juvenile rheumatoid arthritis in doses sufficient to produce a serum salicylate level in excess of 25 mg/100 ml. All 6 patients developed elevations of serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase. In addition, 4 patients had other evidence of hepatic dysfunction. Abnormalities were dose-related and were reversible upon lowering the salicylate dose. Liver biopsies performed in 2 patients revealed a mononuclear cell infiltrate of portal triads in both and scattered single cell necrosis in the parenchyma in 1 case.After decades of use, chronic salicylate therapy remains of central importance in the care of patients with arthritis. This is due, in substantial measure, to the relative infrequency with which such therapy has been associated with serious adverse side-effects. Nonetheless, certain pathophysiologic processes-eg, alterations