Pathogenesis and clinical manifestations of juvenile rheumatoid arthritis

Abstract

Juvenile rheumatoid arthritis (JRA) is the most common rheumatic childhood disease; its onset is before 16 years of age and it persists for at least 6 weeks. JRA encompasses a heterogeneous group of diseases that is classified according to 3 major presentations: oligoarthritis, polyarthritis, and systemic onset diseases. These presentations may originate from the same or different causes that involve interaction with specific immunogenetic predispositions, and result in heterogeneous clinical manifestations. An arthritic joint exhibits cardinal signs of joint inflammation, such as swelling, pain, heat, and loss of function; any joint can be arthritic, but large joints are more frequently affected. Extra-articular manifestations include high fever, skin rash, serositis, and uveitis. The first 2 types of JRA are regarded as T helper 1 (Th1) cell-mediated inflammatory disorders, mainly based on the abundance of activated Th1 cells in the inflamed synovium and the pathogenetic role of proinflammatory cytokines that are mainly produced by Th1 cell-stimulated monocytes. In contrast, the pathogenesis of systemic onset disease differs from that of other types of JRA in several respects, including the lack of association with human leukocyte antigen type and the absence of autoantibodies or autoreactive T cells. Although the precise mechanism that leads to JRA remains unclear, proinflammatory cytokines are thought to be responsible for at least part of the clinical symptoms in all JRA types. The effectiveness of biologic therapy in blocking the action of these cytokines in JRA patients provides strong evidence that they play a fundamental role in JRA inflammation.

Association of neopterin as a marker of immune system activation and juvenile rheumatoid arthritis activity

“…6 Regardless of the differences in the underlying pathogenesis of the various types of JIA, pro-inflammatory cytokines are consistently overproduced and are related to the clinical manifestations in all types of JIA. 7 The International League of Associations for Rheumatology (ILAR) classification system divides JIA into seven clinical subgroups. 8 The few population based estimates available indicate that the prevalence of JIA is approximately one to two per 1,000 children, and the incidence is 11 to 14 new cases per 100,000 children.…”

The Role of Sex in Uveitis and Ocular Inflammation

“…Juvenile idiopathic arthritis (JIA) is a group of auto-immune arthritides that affect children below the age of 16. 10-12 It is more common in females and depending on the sub-type, 50-80% of JIA patients are female. 13 Uveitis is a common manifestation of the disease, occurring in 10-45% of JIA patients.…”

Juvenile Arthritis: Clinical Manifestations and Differential Diagnosis and Differential Diagnosis

“…Круг дифференциальной диагности-ки полиартрита составляет гораздо меньшее чис-ло заболеваний, течение которых сопровождается развитием контрактур -это некоторые формы скелетных дисплазий, артрогрипоз, болезни на-копления, синдром Фарбера, а также ретикуло-гистиоцитоз и ряд других заболеваний (табл. 3) [10,15,16,17,21].…”

“…Любой сустав может являться мишенью ювениль-ного артрита, однако наиболее часто поражаются крупные и средние суставы, а именно коленные, голеностопные, лучезапястные, локтевые, тазобед-ренные, реже -мелкие суставы кистей и стоп. При тяжелых вариантах течения заболевания во-влекаются «синовиальные суставы» шейного отдела позвоночника и височно-нижнечелюстной сустав с развитием деформирующего артроза [12,15,19].…”