| PART ONE: Juvenile IdiopathicArthritis in Children withClinical CharacteristicsAnalysisObjective:To explore the clinical and laboratory data of juvenile idiopathicarthritis, to further improve the understanding of this disease.Methods:Patient records between January2003to January2013wereretrospectively derived from the Children’s Hospital affiliated toShanghai Jiaotong University.The characteristics,clinical manifestations,and laboratory data of177cases of JIA in childhood were retrospectivelyanalyzed.Results:(1) In177cases of children with JIA, the SOJIA type85cases(48.02%); oligoarticular JIA31cases (17.51%), no case withextended oligoarthritis; polyarticular JIA type of34cases(19.21%), of which the RF positive4cases (11.76%), RF negative30cases (88.24%); ERA26cases (14.69%); undefinedJIA type1case.108male and69female (M:F ratio,1.6:1) wereincluded in the study, nearly a half was older than seven years(48.31%). Their age ranged from4months to16years, and themedian age was8.22±3.72years. School-age group (>7years)of constitute more than half (59.32%) of the total. Children ofmale (67.62%), incidence trends are significantly higher thanfemale. ERA with high rates of men, the gender difference wasstatistically significant(P=0.002). Other subtypes of JIA had nogender differences of statistical study (P>0.05). There were nosignificant differences among different aged groups and differenttypes.(2) JIA has various clinical manifestations, including joint symptoms,systemic symptoms, as well as extra-articular symptoms. Mainlycharacterized by fever, rash, arthritis, hepatomegaly,Splenomegaly，lymphadenectasis, and hydrohymenitis. In thecourse of the disease, Complications were macrophage activationsyndrome, iridocyclitis.(3) The diagnosis of JIA is still lack of specific subsidiaryexaminations. Elevated inflammatory indicators such as CRP,ESR.Other subsidiary examinations of Immunological indicators,such as RF, immunoglobulins, HLA-B27, antinuclear antibodies,ferritin,have different degree of abnormality. To define the earlypresence of joint inflammation, Joint MRI has irreplaceableeffect. In addition, blood culture, bone marrow aspiration, andimageological examination can help distinguish infectious andtumor diseases. Conclusion:(1) JIA is a common chronic systemic autoimmune diseasecharacterized by non-suppurative joint synovitis in the childhood.JIA can occur in each age group including infants, preschool, andschool-age children.(2) The diagnosis of JIA mainly depends on the clinical features,especially the differential diagnosis should be done. So far,laboratory investigations have no significant meaning for rulingout or understanding other diseases’ activity.(3) Serum ferritin play an important role in the diagnosis of SOJIA,especially it obviously raised when MAS occurs.(4) During the treatment of JIA, it should prevent MAS, iridocyclitis,and other complications. PART TWO: Significance of Serum Resistin in Diagnosisof Juvenile IdiopathicArthritisObjectiveTo explor the clinical significance of serum resistin in diagnosis ofJIA．Methods30cases of children who confirmed with JIA were selected frominpatient and outpatient in children’s hospital affiliated to ShanghaiJiaotong University; and other rheumatic diseases15cases,12cases ofhealthy children involved as well. Serum resistin levels were measuredby ELISA, and comprehensive analysis was carried out with clinical dataand related laboratory findings．Results(1) The mean serum resistin in the JIA patients (13.05±15.94ng/ml)was significantly higher compared to the control(4.45±5.279ng/ml) and other rheumatic diseases (4.64±4.49ng/ml)(p=0.0175), especially with those SOJIA patients (23.84±19.24ng/ml)(P=0.0003).(2) In JIA group, the result indicates the positive correlationsbetween serum resistin levels and CRP (r=0.4685,P﹤0.0001),WBC (r=0.4713,P﹤0.0001),IL-6(r=0.371,P=0.027) levels.(3) Based on serum resistin≥7.45ng/ml as the positive thresholdvalue，the area under receiver operating characteristic curve was0.89，and the sensitivity and specificity in diagnosis of SOJIAwas76.9%and83.3%respectively．Conclusion(1) Serum resistin is increased in patients with JIA, especially inSOJIA increased significantly;(2) Serum resistin can be used for the diagnosis of SOJIA，and≥7.45ng/ml can be a suitable cut-off level．... |
PDF Full Text Request