Clinicalanalysis Of Polyarticular Juvenile Idiopathic Arthritis In 156 Cases

Objective:To investigate the clinical features,auxiliary examination,treatment and the efficacy of biological agents in 40 children with polyarticular juvenile idiopathic arthritis(pJIA),so as to help the the diagnosis,treatment for pJIA patients.Methods:The clinical data of newly diagnosed children with polyarticular JIA admitted to the Children's Hospital of Chongqing Medical University from January 2008 to December 2017 were analyzed retrospectively.Results:A total of 156 newly diagnosed children with polyarticular JIA were selected,including 58 males and 98 females.The ratio of male to female was about 1:1.7.The average age of initial diagnosis was 8.28 years old,the peak age-bracket of onset was 6 years old to 12 years old,accounting for 57.7% of the total number of pJIA patients.The most common initial symptoms was arthritis and fever.The most commonly involved joints were knee(67.9%),ankle(60.2%),interphalangial joint(55.8%)and wrist(48.1%).Among the laboratory examination indexes,erythrocyte sedimentation rate(ESR),c-reactive protein(CRP)and other inflammatory indexes were increased to varying degrees.RF was positive in 53 cases(33.4%,53/156),anti-CCP antibody was positive in 41 cases(28.7%,41/143),and HLA-B27 was positive in 10 cases(15.4%,10/65).Joint ultrasound revealed 56 cases(91.8%,51/61)of articular effusion and14 cases(23.0%,14/61)of synovial thickening.Joint magnetic resonance imaging revealed joint cavity effusion in 35 cases(57.4%,35/61),joint synovial thickening in 28 cases(45.9%,28/61),bone marrow edema in 13cases(21.3%,13/61),and ligament edema in 7 cases(11.5%,7/61).Bone X-ray examination indicated 37 cases of bone changes(50.7%,37/73).Bone mineral density indicated decreased bone mass in 33 cases(58.9%,33/56).156 cases were treated with nonsteroidal antiinflammatory drugs(100%).139 cases were combined with disease modifying antirheumatic drugs.80 cases of them were treated with biologic agents,Etanercept(46cases,57.5%),infliximab(30 cases,37.5%)and tocilizumab(4 cases,5%)due to poor efficacy and poor prognostic factors.Among them,40 cases(29cases of infliximab,7 cases of etanercept and 4 cases of tocilizumab)were followed up for treatment with biologic agents.37 cases showed varying degrees of improvement in clinical symptoms,laboratory inflammatory indicators and JADAS27 score,with no obvious side effect.Conclusion: The incidence of polyarticular JIA is higher in children of school age.The incidence of female children was significantly higher than that of male children.The positive rate of RF and ACCP is not high.The laboratory index such as CRP,ESR have no obvious specificity and sensitivity.Joint ultrasound and magnetic resonance imaging can be used to detect early joint inflammation and JADAS27 can be used to evaluate disease activity and efficacy.Biological agents are safe and effective in the treatment of pJIA.