The Clinical Study Of 89 Cases With Oligoarticular And Polyarticular Juvenile Idiopathic Arthritis

Objective: To investigate characteristics of clinical manifestation, diagnosis and therapy in children with oligoarticular and polyarticular Juvenile Idiopathic Arthritis (JIA).Methods: The medical records of 89 children who had oligoarticular or polyarticular JIA treated in Children's Hospital of Chongqing Medical University from 2005 through 2010 were retrospectively reviewed. Clinical and laboratory data, including their gender, age, clinical manifestations, laboratory tests, imaging data, diagnosis and treatment regimens of the two subtypes were collected and analyzed.Results:1. Of the 89 cases, 42 boys and 47 girls (M:F ratio,1:1.1) were included in the study, nearly a half was older than eight years (48.31%). Their age ranged from 8 months to 16 years, and the median age was 7.91±3.94 years. There were 37 cases with oligoarticular JIA, no case with extended oligoarthritis, 52 cases with polyarticular JIA, consisting of 10 cases with rheumatoid factor positive (RF+), 27 cases with rheumatoid factor negative (RF-). The mean duration of disease was 16.80±24.91 months. 2. Oligoarticular and polyarticular JIA were mainly characterized with joint symptoms, while systemic and extra-articular symptoms were rare. Oligoarthritis was predominantly a disease of the legs, with the knee joints mostly affected(28.00%), followed by the ankles(21.33%) and hips(17.33%). Polyarthritis also affected the large joints at onset, usually knees(20.00%) and ankles(18.50%), but usually in association with small joints of the hands(18.00%) and wrist joints(16.00%). Chronic iridocyclitis was recognized in 4 cases (4.50%), one of which had a surgical treatment because of corneal ulcer. 3. Laboratory investigions were rarely pathognomonic, and were used to help differential diagnosis. Elevated inflammatory indicators such as erythrocyte sedimentation rate, C-reactive protein, and immunoglobulins were common during the acute illness. Rheumatoid factors and autoantibody were found in the patients. During the acute phase ultrasound was superior to clinical examination in the diagnosis and localization of bursal effusion and synovitis. Radiographic features of local bone pathology became more useful for the differential diagnosis with the extension of the course. Bone marrow aspiration, CT and MRI scan helped to exclude the tumor and tuberculosis infection. 4. Of the 89 cases, 76 cases were treated with NSAIDs, 61 cases were added with DMARDs, 49 cases was with a combination therapy of NSAIDs, MTX and TGP. For the 13 refractory cases, tumor necrosis factor receptor - antibody fusion protein had been used for 3~12 months; longest follow-up to 3 years, all the joint symptoms were relieved without adverse reaction.Conclusions:1. JIA is a common chronic systemic autoimmune disease characterized by non-suppurative joint synovitis in the childhood. Oligoarticular and polyarticular JIA are mainly characterized with joint symptoms, less involvement of other systems. JIA can occur in each age group including infants, preschool young children and school-age children. The females with polyarthritis are significantly more than male.2. The large joints, usually knees and ankles, are affected in the JIA, involvement of hip joint in oligoarthritis should be noted, while it is common in association with small joints of the hands in polyarthritis. Periodic eye examinations help to avoid iridocyclitis.3. The diagnosis of JIA mainly depends on the symptoms and signs, especially the differential diagnosis should be done. Laboratory investigations are rarely pathognomonic and were used to help differential diagnosis.4. It is necessary to start treatment for JIA early, which also needs to be individualized based on the JIA subtypes. Long-term standard combination therapy should be done to relieve symptoms and slow the progress of the disease, in order to avoid deformity, blindness and other complications. It is recommended to minimize systemic use of corticosteroids for the treatment of oligoarticular and polyarticular JIA. Methotrexate has been proven safe and effective, and been the treatment cornerstone for most patients with polyarthritis. Biological agents such as tumor necrosis factor receptor - antibody fusion protein is effective to relieve the joint symptom, and improve the prognosis of JIA.