Juvenile arthritis: current concepts in terminology, etiopathogenesis, diagnosis, and management

Abramowicz, Shelly; Kim, S.; Prahalad, Sampath; Chouinard, Audrey; Kaban, Leonard B.

doi:10.1016/j.ijom.2016.03.013

Cited by 54 publications

(29 citation statements)

References 84 publications

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“…Involvement of the hip, cervical spine and shoulder could be seen as well. Temporomandibular arthritis is present in the majority of patients, resulting in secondary microretrognathia (3,6,29). These disease subtypes are associated with a high rate of damage, especially hip joint involvement, which is related to high morbidity and surgical interventions (30).…”

Section: Juvenile Idiopathic Arthritis Subtypesmentioning

confidence: 99%

Juvenile Idiopathic Arthritis

et al. 2017

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Juvenile idiopathic arthritis is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent fever and rash. Oligoarticular juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis. Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity arthritis. This disease subtype represents the childhood form of adult spondyloarthropathies, with human leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash, accompanied by arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and osteoporosis secondary to treatment and disease activity, to life-threatening macrophage activation syndrome with multi-organ insufficiency. With the advent of new therapeutics over the past 15 years, there has been a marked improvement in juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals of treatment are to eliminate active disease, to normalize joint function, to preserve normal growth and to prevent long-term joint damage. Timely and aggressive treatment is important to provide early disease control. The first-line treatment includes disease-modifying anti-rheumatic drugs (methotrexate, sulphasalazine, leflunomide) in combination with corticosteroids, used in different dosages and routes (oral, intravenous, intra-articular). Intra-articular application of steroids seems to be an effective treatment modality, especially in monoarthritis. Biological agents should be added in the treatment of unresponsive patients. Anti-tumour necrosis factor agents (etanercept, infliximab, adalimumab), anti-interleukin-1 agents (anakinra, canakinumab), anti- interleukin-6 agents (tocilizumab) and T-cell regulatory agents (abatacept) have been shown to be safe and effective in childhood patients. Recent studies reported sustained reduction in joint damage with even complete clinical improvement in paediatric patients, compared to previous data.

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Section: Juvenile Idiopathic Arthritis Subtypesmentioning

confidence: 99%

Juvenile Idiopathic Arthritis

et al. 2017

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“…3 Studies have found that more than 70% of the patients evaluated have structural condylar alterations in radiographic examinations, but not all have clinical signs. 5 The patient in this case report had a controlled disease, with no complaint of pain in any joint. Approximately 50% of the children with JIA have the active disease in adult life.…”

Section: Discussionmentioning

confidence: 68%

“…3 Condylar alterations are frequent, and patients may be asymptomatic even in the presence of severe TMJ changes. 4,5 Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder beginning in childhood and is defined by harmful levels of inattention, motor hyperactivity and impulsivity. 6 The estimated prevalence in children is 3.4% (95% CI 2.6 -4.5) according to the most recent meta -analysis 7 and is more common in males.…”

Section: Introductionmentioning

confidence: 99%