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HILDREN with rheumatoid disease present problems in management C that merit separate attention. Still, in his now famous monograph published around the turn of the century, impressed on our awareness the prominence of the systemic reaction (fever, rash, anemia, glandular sweIIing, muscle wasting) seen in young children. Despite this, only in the past decade has an interest in the therapeutic aspects of the growing individual with arthritis been recorded.2$s-10 The cyclic waves of physician support for methods of treatment of arthritis in children have stabilized recently and agreement in principle seems to have been reached. Experience has shown that working with the family unit, rather than with the child alone, and using common sense methods, a more optimistic outlook can be predicted than has previously been Philosophy: Condensing in a few paragraphs the protean manifestations of childhood arthritis, its variable course, the range of severity, the frustrations and rewards of working with these children, is difficult. Yet it is the principles of child care and awareness of their broad needs in the face of a disease process of variable duration and intensity that probably influences morbidity more than any particular drug or group of execises. The goals of treatment are, whenever possible, to have the child live at home, attend regular school and remain free o€ contractures and deformity. This picture can often be realized if the resources around us are mobilized to minimize the child's disability.Recopifion: Effective description in publicationss of the systemic presenting symptoms of a nonarthritic nature occurring in juvenile rheumatoid disease has done a great deal to stimulate early diagnosis. This aids management in the prevention of deformity and muscle wasting. Inappropriate prediagnostic handling ( casting, antibiotics, operations) can be minimized through increased physician awareness and early referral to a treatment center where personnel with experience in this illness assist early recognition.Hospitalization: Most children can have their diagnosis established and their therapy set out without necessitating hospital admission once a community or an area comes to grips with the provision of facilities for dealing with arthritis in children on a team basis. This does not imply that a hospital admission is never indicated but it infers instead that the duration of hospital stays will be greatly shortened when careful attention is given to the needs of the child. The concept of hospital bed care is one to be avoided as part of the treatment plan and only used when severity of symptoms (pericarditis, septic course) warrant it.
HILDREN with rheumatoid disease present problems in management C that merit separate attention. Still, in his now famous monograph published around the turn of the century, impressed on our awareness the prominence of the systemic reaction (fever, rash, anemia, glandular sweIIing, muscle wasting) seen in young children. Despite this, only in the past decade has an interest in the therapeutic aspects of the growing individual with arthritis been recorded.2$s-10 The cyclic waves of physician support for methods of treatment of arthritis in children have stabilized recently and agreement in principle seems to have been reached. Experience has shown that working with the family unit, rather than with the child alone, and using common sense methods, a more optimistic outlook can be predicted than has previously been Philosophy: Condensing in a few paragraphs the protean manifestations of childhood arthritis, its variable course, the range of severity, the frustrations and rewards of working with these children, is difficult. Yet it is the principles of child care and awareness of their broad needs in the face of a disease process of variable duration and intensity that probably influences morbidity more than any particular drug or group of execises. The goals of treatment are, whenever possible, to have the child live at home, attend regular school and remain free o€ contractures and deformity. This picture can often be realized if the resources around us are mobilized to minimize the child's disability.Recopifion: Effective description in publicationss of the systemic presenting symptoms of a nonarthritic nature occurring in juvenile rheumatoid disease has done a great deal to stimulate early diagnosis. This aids management in the prevention of deformity and muscle wasting. Inappropriate prediagnostic handling ( casting, antibiotics, operations) can be minimized through increased physician awareness and early referral to a treatment center where personnel with experience in this illness assist early recognition.Hospitalization: Most children can have their diagnosis established and their therapy set out without necessitating hospital admission once a community or an area comes to grips with the provision of facilities for dealing with arthritis in children on a team basis. This does not imply that a hospital admission is never indicated but it infers instead that the duration of hospital stays will be greatly shortened when careful attention is given to the needs of the child. The concept of hospital bed care is one to be avoided as part of the treatment plan and only used when severity of symptoms (pericarditis, septic course) warrant it.
SUMMARY Rheumatoid arthritis occurs not infrequently in childhood. Girls are afflicted more often than boys. The form known as Still's disease seems to be less common in Sweden. The onset of the disease in children differs from that in adults in that the larger joints are more often attacked. The joints of the lower extremities are usually affected, especially the knee joints. The process frequently begins as a monarthritis. In preliminary stage it is often wrongly diagnosed as tubercular arthritis. Besides the arthritical symptoms it begins insidiously with subfebrile temperature, moderate increase in the SB, moderate hypochromic anaemia and signs for myocardial injury. X‐ray manifestations of heart‐dilatation generally becomes evident first in later stages. Sometimes peritendinitis and subcutaneous nodules. Processes in the eyes occur. Eosinophilia is common. The tendency to flexion contractures is often marked. The movement treatment of the joints is an important part of the therapy in avoiding defects. Internal anti‐infectious therapy is also important because of the often pronounced infectious character of the disease (gold‐salts or sulfonamides‐preparations). For decreasing the hyperergic reaction of the tissues salicylic acid or amidopyrine is given. The prognosis appears to be relatively good – except of the cases of Still's disease. The duration of the disease is on an average from 2 to 3 years for those patients who are cured. Protracted care on hospital is necessary, preferably on arthritic clinics.
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