The prognosis in rheumatoid arthritis in childhood

Abstract

Chronic polyarthritis in childhood is a disease of considerable frequency.In the medical wards of the Hospital for Sick Children, Great Ormond Street, sixty-nine cases have been treated since the war. There are additional outpatient cases which are not admitted to the wards and it is estimated that a new case may be seen at the hospital every twelve weeks.In the wards the clinical picture of the acute phase is familiar, but apart from certain cases with early recovery the end results are seldom seen, so prolonged is the course of the disease. The institutions for chronic rheumatoid arthritis collect the most severely crippled but these form a minority. The fairest assessment of prognosis is attained by a follow-up enquiry of a consecutive hospital series and for this purpose the post-war cases have been taken. The cases under reviewThe series of sixty-nine is depicted in fig. 1 where the cases are arranged according to the age of onset. Two cases are seen to have begun in the first year of life, fourteen cases in the third year with a maximum incidence in the pre-school period between two and five years. The sex incidence is also indicated. Sixty per cent. of the patients were girls.Follow-up results. The results of the follow-up enquiry are shown in fig. 2. Enquiries were successful in forty-nine cases (twenty cases were untraced). Of these, twelve are known to have died, eighteen are still active and nineteen are quiescent. The criteria of quiescence have been an absence of joint pain and tenderness for a period of not less than two years, and a blood sedimentation rate within normal limits. In no instance have symptoms recurred after a quiescent period of eighteen months.The fatal cases. A recognition of the considerable mortality was the first finding of importance ( fig. 2). Twelve of the patients followed have died and in each case before reaching adult age. Each fatal case had first developed the condition under five years of age and with one exception each one had died within three years of the onset. The disease is thus most dangerous in the acute stages in the young children. Figure 1 shows that forty-two of the cases developeid symptoms in the first five years of life. Of these, twelve are dead-a mortality of nearly thirty per cent. at this period. The disease is thus most fatal in the years when it is most frequent.

Juvenile Rheumatoid Arthritis: A Follow-up of 75 Cases

“…In the present material, it is also possible to observe an association between a prolonged active period and a poor final result (as pointed out, among others, by Colver, 1937;Sury, 1952, andNorcross et al, 1958). Coss and Boots (1946) have mentioned leucocytosis as a poor prognostic sign.…”

Observations on the Clinical Course and Treatment of One Hundred Cases of Still's Disease

“…Moreover, they were milder cases and this was the main reason they were only given symptomatic treatment. 'Historical' controls are also unsatisfactory, but, nevertheless, the results in our more severe cases treated with steroids are much better than those reported by Colver (1937), using the general measures, which were all that were available at that time. Deaths are now much less common and there are many more complete recoveries.…”

The Heart in Rheumatoid Arthritis

“…Colver (1937) in 69 children with Still's disease detected carditis during life in only 1; of 4 studied at autopsy none had carditis. Hench and Rosenberg making a study of all their arthritic patients on a given date (1941) found none with clinical or electrocardiographic evidence of carditis.…”