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Clinical observations of juvenile rheumatoid arthritis

Korean Journal of Pediatrics 2006;49(4):424-430.
Published online April 15, 2006.
Clinical observations of juvenile rheumatoid arthritis
Joo Hoon Lee, Jeong Min Ryu, Young Seo Park
Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
연소성 류마티스 관절염의 임상적 고찰
이주훈, 유정민, 박영서
울산대학교 의과대학 서울아산병원 소아과
Correspondence: 
Young Seo Park, Email: yspark@amc.seoul.kr
Abstract
Purpose
: Juvenile rheumatoid arthritis(JRA) is one of the most common rheumatic diseases of childhood and is an important cause of short- and long-term disability. The purpose of this study was to determine the disease course and outcome in childhood patients with JRA.
Methods
: Fifty nine patients with JRA who were diagnosed and treated in the Department of Pediatrics, Asan Medical Center from August 1990 to November 2004 were enrolled in this study. Sex, age, type, affected joints, extra-articular manifestations, laboratory and radiologic findings, treatments, and outcomes of JRA patients were reviewed retrospectively.
Results
: Among JRA patients, 32.2 percent had pauciarticular type, 30.5 percent had polyarticular type and 37.3 percent had systemic type. The ratio of boys to girls was 1.7 : 1 and the mean age at onset was 9.3¡¾3.7(1.3-15.9) years. The most commonly affected joints were knee, ankle and wrist. The extra-articular manifestations observed were fever, rash, myalgia and lymph node enlargement, etc. The main laboratory findings observed were leukocytosis, anemia, thrombocytosis, elevated ESR, and elevated CRP. Rheumatoid factor and antinuclear antibody(ANA) were positive in 5.3 percent and 18.0 percent. Nonsteroid anti-inflammatory drugs(NSAID) were used most frequently and methotrexate with or without steroids was added in 27.1 percent of patients unresponsive to NSAID. 88.1 percent of patients were cured without functional disability and only one patient was in functional status IV. One patient, who had pulmonary involvement, died.
Conclusion
: Our results showed an even distribution in type of onset, male predominance, older age of onset, low incidence of iridocyclitis, and low positivity of ANA in JRA patients; this differs from occidental data. This study may suggest regional differences and variability in disease groups of JRA among different racies, but further multi-center trials and large scale epidemiological studies are needed to confirm our conclusion.
Key Words: Juvenile rheumatoid arthritis , Pauciarticular type , Polyarticular type , Systemic type


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