| Objective:To investigate characteristics of clinical manifestation,diagnosis and therapy in children with Juvenile Idiopathic Arthritis(JIA),to further improve the understanding of this diseaseMethods:Patient records between April 2011 to December 2016 were retrospectively derived from the Children's Hospital affiliated to Suzhou University.The characteristics,clinical manifestations,laboratory data and treatment of 105 cases of JIA in childhood were retrospectively analyzed.Results:(1)In 105 cases of children with JIA,the SOJIA type 66 cases(42.58%);oligoarticular JIA 26 cases(24.76%);polyarticular JIA type of 30 cases(19.36%),of which the RF positive 6 cases(20%),RF negative 24 cases(80%);ERA 31 cases(20.0%);psoriatic JIA 2 cases(1.29%);92 male and 63 female(M:F ratio,1.46:1)were included in the study.Their age ranged from 1year to 15.75 years,and the median age was 7.89±3.94 years.School-age group(> 7 years)of constitute more than half(60.64%)of the total,among them,62.76% were male,and the incidence was slightly higher than that of female.ERA with high rates of men,the gender difference was statistically significant(P=0.001).Other subtypes of JIA had no gender differences of statistical study(P>0.05).There were no significant differences among different aged groups and different types.(2)JIA has various clinical manifestations,including joint symptoms,systemic symptoms,as well as extra-articular symptoms.Mainly characterized by fever,rash,arthritis,hepatomegaly,Splenomegaly,lymphadenectasis,and hydrohymenitis.In the course of the disease,Complications were macrophage activation syndrome,iridocyclitis.(3)The diagnosis of JIA is still lack of specific subsidiary examinations.Elevated inflammatory indicators such as CRP,ESR.Other subsidiary examinations of Immunological indicators,such as RF,immunoglobulins,antinuclear antibodies,ferritin,have different degree of abnormality.To define the early presence of joint inflammation,Joint X-ray,CT,MRI,ultrasound examination has irreplaceable effect.In addition,blood culture,bone marrow aspiration,and imageological examination can help distinguish infectious and tumor diseases.(4)treatment:So JIA:There were 8 cases of systemic JIA complicated with MAS in all the 66 patients with systemic JIA,58 cases were relieved after initial treatment;10 cases of systemic JIA hormone reduction after repeated illness,plus cyclosporine A treatment after 1 months,7 cases were significantly relieved,and no remission 3 cases were clinical remission after tacrolimus treatment;oligoarticular JIA:Initial use of NSAIDs treatment,4 of them achieved satisfactory results;The other 22 cases using NSAIDs+DMARDs combined therapy,15 cases for 1 months after NSAIDs+DMARDs joint pain symptoms were not obvious,MRI still has a joint effusion,treated with low-dose prednisone or etanercept therapy;There are 4 cases of iridocyclitis in children with acute intravenous infusion of methylprednisolone,plus local Tobramycin and Dexamethasone Ophthalmic Suspension,good control of ocular symptoms.polyarticular JIA:All the children were the first to use NSAIDs+DMARDs combined treatment,1 months after the treatment,12 cases of multi joint type JIA after NSAIDs+DMARDs treatment significantly relieved;another 18 cases of multi joint type JIA by NSAIDs+DMARDs after treatment of joint pain,joint review of MRI still have to tip effusion,combined with glucocorticoid,were given low-dose oral prednisone;of which 3 cases the effect is still poor,with etanercept treatment to alleviate.ERA:6 cases with NSAIDs symptoms relieved;7 patients with NSAIDs+DMARDs were alleviated;the other 18 patients with NSAIDs+DMARDs(oral MTX)+ hormone(prednisone)treatment,of which 13 cases were relieved obviously,and 5 cases of poor treatment effect with the use of etanercept in the treatment significantly alleviated.MAS:In 8 cases of children with MAS were treated with individualized treatment with large doses of methylprednisolone,20 ~ 30mg/(kg·d)continuous shock for 3 days,gamma globulin treatment 1 g /(kg·d)for a period of 2 days,and oral or intravenous infusion of cyclosporine A 3 ~ 8mg/(kg·d),the other 3 cases based on the use of TNFalpha inhibitors(etanercept)treatment,7 patients after therapy,1 cases died of hepatic coma.PsJIA:Using NSAIDs(ibuprofen)+ etanercept therapy has the obvious curative effect.Conclusions:(1)The clinical manifestations of JIA are not typical,the diagnosis of JIA mainly depends on the clinical features,especially the differential diagnosis should be done.(2)Considering the possibility of MAS in patients with So JIA,such as fever,liver damage,multiple system damage and ferritin,the early diagnosis of MAS and active combination therapy are important to improve the prognosis.(3)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.(4).If the conventional treatment effect is not good,should be added as soon as possible biological agents... |
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