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Nature Reviews. Rheumatology May 2021Chronic inflammatory arthritis in childhood is heterogeneous in presentation and course. Most forms exhibit clinical and genetic similarity to arthritis of adult onset,... (Review)
Review
Chronic inflammatory arthritis in childhood is heterogeneous in presentation and course. Most forms exhibit clinical and genetic similarity to arthritis of adult onset, although at least one phenotype might be restricted to children. Nevertheless, paediatric and adult rheumatologists have historically addressed disease classification separately, yielding a juvenile idiopathic arthritis (JIA) nomenclature that exhibits no terminological overlap with adult-onset arthritis. Accumulating clinical, genetic and mechanistic data reveal the critical limitations of this strategy, necessitating a new approach to defining biological categories within JIA. In this Review, we provide an overview of the current evidence for biological subgroups of arthritis in children, delineate forms that seem contiguous with adult-onset arthritis, and consider integrative genetic and bioinformatic strategies to identify discrete entities within inflammatory arthritis across all ages.
Topics: Arthritis, Juvenile; Child; Computational Biology; Humans; Phenotype; Polymorphism, Single Nucleotide; Terminology as Topic
PubMed: 33731872
DOI: 10.1038/s41584-021-00590-6 -
Pediatrics in Review Mar 2023Musculoskeletal complaints are common among children in the primary care setting. Joint pain can be categorized as either inflammatory or noninflammatory (also known as...
Musculoskeletal complaints are common among children in the primary care setting. Joint pain can be categorized as either inflammatory or noninflammatory (also known as mechanical), and differentiating between these 2 categories affects a physician's differential diagnosis and plan for evaluation. Patients with inflammatory arthritis will frequently present to the primary care physician with musculoskeletal complaints. Specific features in the history and physical examination distinguish juvenile idiopathic arthritis (JIA) from other musculoskeletal etiologies. (1)JIA is the most common cause of inflammatory joint pain in children younger than 16 years, with a variable worldwide incidence; in Europe and North America, the incidence is approximately 7.8 to 8.3 per 1,000, with prevalence rates between 12.8 and 45 per 100,000. (2) It is thought that as many as 8 million children in the world have chronic arthritis. (2) Given its prevalence, it is important for the primary care physician to be able to appropriately recognize this condition and in doing so prevent a delay in diagnosis and management. Arthritis is a common cause of disability in children, and complications of JIA can be severe. Many therapies used in JIA have adverse effects and contraindications (specifically vaccinations and teratogen exposure) that require recognition by the primary care physician. This article discusses the differences between inflammatory and noninflammatory joint pain, the diagnosis and various categories of JIA, long-term outcomes and complications associated with JIA, and the general management of JIA with special emphasis on adverse effects and contraindications of therapies.
Topics: Child; Humans; Arthritis, Juvenile; General Practitioners; Arthralgia; Drug-Related Side Effects and Adverse Reactions; Pain
PubMed: 36854831
DOI: 10.1542/pir.2021-005456 -
Pediatrics International : Official... Dec 2021The rate of glucocorticoid (GC) use is significantly higher in systemic juvenile idiopathic arthritis (SJIA) than other juvenile idiopathic arthritis subtypes. There is...
BACKGROUND
The rate of glucocorticoid (GC) use is significantly higher in systemic juvenile idiopathic arthritis (SJIA) than other juvenile idiopathic arthritis subtypes. There is no consensus on the duration and dosage of GC treatment. We aimed to investigate the risk factors for a polyphasic / persistent disease course and the effect of dose and duration of GC treatment on SJIA prognosis.
METHODS
Forty-two patients who were diagnosed with SJIA, and for whom the duration of disease was longer than 2 years, were included. Patients were divided into monophasic and others (polyphasic / persistent disease course). Risk factors for polyphasic / persistent disease course, which were clinical and laboratory findings regarding the patients, treatment options, dose, and duration of GCs, were evaluated for the first active disease periods and for all flares in the entire disease course.
RESULTS
Of the 42 SJIA patients, 21 had monophasic, and 21 had polyphasic / persistent disease. Cumulative dosages and durations of glucocorticoid treatment were similar in the two groups at the first flare (odds ratio (OR): 1.032 P: 0.671; OR:1,113 P: 0.115). Durations of the first active disease period were longer in the polyphasic / persistent group (OR:1.275, P: 0.01). Active disease duration cut-off values of 1.5 months with sensitivity 85.7%, specificity 52.4% were observed on receiver operating characteristic curve analysis. The presence of hepatosplenomegaly at first flare was detected as an independent risk factor of polyphasic/persistent disease by multivariate analysis included both dosage and duration of a steroid (hazard ratio (HR): 4.129, P: 0.034), (HR: 3.992, P: 0.038). Multivariate recurrent events survival analysis determined ALT levels as a risk factor affecting polyphasic / persistent disease (HR: 0.986, P: 0.037).
CONCLUSIONS
Glucocorticoid dose and duration did not affect the active disease periods and disease course in SJIA. An active disease period longer than 1.5 months, presentation of hepatosplenomegaly at the initial disease course, and high ALT levels at the recurrences should warn physicians of polyphasic / persistent disease.
Topics: Arthritis, Juvenile; Disease Progression; Glucocorticoids; Humans; Prognosis
PubMed: 33760311
DOI: 10.1111/ped.14706 -
Seminars in Arthritis and Rheumatism Dec 2019Juvenile idiopathic arthritis (JIA) is not a disease but an umbrella term that gather all forms of chronic arthritis of unknown origin and with onset in childhood. Some... (Review)
Review
Juvenile idiopathic arthritis (JIA) is not a disease but an umbrella term that gather all forms of chronic arthritis of unknown origin and with onset in childhood. Some of these disorders appear to be the childhood equivalent of adult diseases and share therefore the same therapeutic targets. A form characterized by early onset and antinuclear antibody positivity seems to be specific for children but further evidence is needed. Systemic JIA (sJIA), although equivalent to adult onset Still disease is much more frequent in childhood. Novel potential targets for sJIA as well as for macrophage activation syndrome, its more severe complication, have therefore been investigated mainly in children.
Topics: Adolescent; Arthritis, Juvenile; Biological Factors; Child; Clinical Trials as Topic; Humans; Immunity, Cellular
PubMed: 31779842
DOI: 10.1016/j.semarthrit.2019.09.017 -
Bulletin of the Hospital For Joint... Mar 2019Juvenile idiopathic arthritis is a heterogeneous group of conditions encompassing all forms of unknown origin arthritis before the age of 16 years that persist for more... (Review)
Review
Juvenile idiopathic arthritis is a heterogeneous group of conditions encompassing all forms of unknown origin arthritis before the age of 16 years that persist for more than 6 weeks. It is the most common rheumatic disease in young patients and causes severe disabilities, thus an early initiation of the appropriate treatment modalities is necessary. First therapeutic options are nonsteroidal anti-inflammatory drugs, corticosteroids, and conventional non-biologic disease-modifying anti-rheumatic drugs, such as methotrexate. Insufficiency of these drugs led to the introduction of new biological medications that selectively target specific cytokines with an objective to suppress the disease. Despite the success in treatment and physical therapy, some of the patients develop advanced arthritis that can result in severe pain and disability. In such cases, surgical intervention is required to improve quality of life. The surgical methods include soft tissue release, osteotomies, synovectomies, and arthrodesis. Total joint replacement is the last option for endstage degenerative conditions (patients with deformity, poor motion, and severe pain). Deep infections, bone perforation, acetabular protrusion, postoperative dislocations, and the need for re-operation are some of the complications of total joint arthroplasty. This review summarizes published studies of the treatment of juvenile idiopathic arthritis focusing mainly on surgical treatment. Our purpose is to evaluate the general trends in treatment of juvenile idiopathic arthritis, focusing on methods, therapeutic advances, and outcomes of the intervention applied.
Topics: Adolescent; Arthritis, Juvenile; Conservative Treatment; Humans; Postoperative Complications; Quality of Life; Reoperation; Surgical Procedures, Operative; Treatment Outcome
PubMed: 31128579
DOI: No ID Found -
Pediatric Radiology Jun 2018Hip involvement is common and estimated to occur in approximately 35-63% of children with juvenile idiopathic arthritis (JIA). It is more prevalent in the aggressive... (Review)
Review
Hip involvement is common and estimated to occur in approximately 35-63% of children with juvenile idiopathic arthritis (JIA). It is more prevalent in the aggressive systemic subtypes, with irreversible changes occurring as early as within 5 years of diagnosis. Whilst clinical parameters and joint examination can be useful for assessing disease severity, subclinical disease is known to exist and delayed treatment may herald a lifetime of disability and pain. Early recognition of JIA changes is therefore crucial in determining treatment options. Validated scoring systems in the radiologic assessment of the hip for clinical drug trials may inform treatment outcomes, although robust tools for analysis are still lacking. This review article details the modalities utilised for imaging the hip in children with JIA with particular efforts focused upon reliability and validity in their assessment of joint disease. We conclude with a short literature review on the potential future techniques being developed for hip joint imaging in JIA.
Topics: Arthritis, Juvenile; Child; Diagnosis, Differential; Disease Progression; Hip Joint; Humans
PubMed: 29766251
DOI: 10.1007/s00247-017-4022-7 -
Ophthalmology Apr 2020
Topics: Adrenal Cortex Hormones; Anti-Allergic Agents; Arthritis, Juvenile; Cataract; Child; Humans; Uveitis
PubMed: 32200820
DOI: 10.1016/j.ophtha.2019.10.042 -
Pediatric Radiology Jun 2018In juvenile idiopathic arthritis (JIA), imaging is increasingly used in clinical practice. In this paper we discuss imaging of the knee, the clinically most commonly... (Review)
Review
In juvenile idiopathic arthritis (JIA), imaging is increasingly used in clinical practice. In this paper we discuss imaging of the knee, the clinically most commonly affected joint in JIA. In the last decade, a number of important steps have been made in the development of imaging outcome measures in children with JIA knee involvement. Ultrasound is undergoing a fast validation process, which should be accomplished within the next few years. The validation processes of MRI as an imaging biomarker for clinical trials in the JIA knee are at an advanced stage, with important data available on the feasibility, reliability and validity of the Juvenile Arthritis MRI Scoring system. Moreover, both US and MRI data are emerging on the normal appearance of the growing knee joint.
Topics: Arthritis, Juvenile; Child; Diagnosis, Differential; Humans; Knee Joint
PubMed: 29766248
DOI: 10.1007/s00247-017-4015-6 -
Archives of Disease in Childhood.... Jun 2022Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease affecting children and young people today. However, it is not a single disease entity,... (Review)
Review
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease affecting children and young people today. However, it is not a single disease entity, but an umbrella term that gathers together a heterogeneous collection of complex, chronic inflammatory conditions with oligoarticular JIA the most common form in both Europe and North America. Due to its relative rarity in daily practice and potential to mimic other conditions, oligoarticular JIA can present a diagnostic and management challenge to healthcare professionals in both primary care and general paediatrics. The aim of this article is to provide a summary of the key aspects of diagnosis, investigation and management of this condition, with the hopes of building clinicians' confidence when facing a possible case of oligoarticular JIA.
Topics: Adolescent; Arthritis, Juvenile; Child; Europe; Humans
PubMed: 34083213
DOI: 10.1136/archdischild-2020-321088 -
Current Rheumatology Reports Nov 2017This review assesses the long-term remission and predictors of clinical outcome in patients with juvenile idiopathic arthritis (JIA). A comprehensive literature search... (Review)
Review
PURPOSE OF REVIEW
This review assesses the long-term remission and predictors of clinical outcome in patients with juvenile idiopathic arthritis (JIA). A comprehensive literature search was performed including articles published between January 1, 2004 and February 28, 2017. Studies, with a minimum follow-up of 24 months, were selected independently by two reviewers based on in- and exclusion criteria. The objective outcome was inactive disease/clinical remission as defined by the Wallace criteria at last follow-up.
RECENT FINDINGS
The probability of achieving inactive disease and/or clinical remission is dependent on the JIA subcategories studied in the different articles. Overall, a significant proportion of JIA patients still showed signs of active disease at last follow-up. Some studies include patient populations followed for 15 years or more and these patients were exposed to different treatment protocols at disease presentation than patients diagnosed in the biologic era. Although the severity of the morbidity and associated mortality risk has decreased over time, a significant proportion of the current JIA patients still do not reach an inactive disease status within a 2-year follow-up window. Studying the long-term outcome of patients with JIA remains challenging due to the heterogeneity of the study designs and study populations. Although improvement has been shown in the biologic era, we still need to enhance the number of patients with inactive disease within the first 2 years after diagnosis.
Topics: Antirheumatic Agents; Arthritis, Juvenile; Child; Humans; Remission Induction; Severity of Illness Index; Treatment Outcome
PubMed: 29101579
DOI: 10.1007/s11926-017-0702-4