Clinical Analysis Of 59 Cases With Systemic Juvenile Idiopathic Arthritis

Objective:The study analyzed the clinical characteristics,auxiliary examination and treatment of 59 cases with systemic juvenile idiopathic arthritis(s JIA),and to raise awareness of the disease and treatment timely.Methods:1.A retrospective analysis was performed on the epidemiology,clinical manifestations,laboratory tests,imaging examination and treatment of 59 cases with s JIA diagnosed and hospitalized at Children’s Hospital Affiliated to Soochow University from January 2014 to January 2018.2.The clinical manifestations,affected joint locations,and laboratory examination characteristics were analyzed between s JIA subtypes.3.Randomly selected children from January 2017 to August 2017 as elective surgery as a control group,and they also improved preoperative peripheral blood routine,C-reactive protein,lymphocyte subsets,humoral immunity and complement.White blood cell,neutrophil counts,monocyte counts,lymphocyte co unts,C-reactive protein,lymphocyte subsets,humoral immunity Ig A,Ig G,Ig M,and complement C3,C4 were compared between patients with s JIA and controls.4.Summarize the treatment of s JIA patients,efficacy evaluation and prognosis.5.Summarize the individualized treatment and prognosis of s JIA with macrophage activation syndrome(MAS).Result:1.Among the 59 cases with s JIA patients,there were 33 males and 26 females,and the ratio between males and females was about 1.27/1.The onset age ranged from 1.33to 16 years and the average age was 7.80±4.02 years.2.59 cases of s JIA patients have fever,arthritis clinical manifestations.The fever time ranged from 7 to 42 days,and the average was 17.50±7.90 days,mostly remittent fever.The most commonly affected joints in s JIA patients were knee joints,ankle joints,and hip joints.Other common clinical manifestations were rash,swollen lymph nodes,hepatosplenomegaly,and serous effusions.3.The higher rates of alanine aminotransferase,aspartate aminotransferase,and platelet and the decrease rate of fibrinogen in type III were significantly higher than those in type I and II(P<0.017).The increase rate of complement C3 in patients with type III s JIA was significantly lower than that in type I and type II(P<0.017).4.With regard to imaging examination of 59 patients with s JIA,11 cases(18.64%)had no obvious manifestations of arthritis in the early stage of the disease,but arthritis was shown on radiographic examinations within six months of discharge.In addition,among the 29 patients with s JIA whose X-ray examination showed no obvious arthritis,26 cases with re-examination MRI and 13 cases with re-examination B-ultrasound showed bone marrow edema,joint effusion,and synovitis and other signs of a rthritis.5.The percentage and count of CD3~+in patients with active s JIA were statistically significant compared with the control group(P<0.05).Among them,there was a statistically significant difference in the CD3~-CD8~+count between the two groups(P<0.05).The percentages and counts of CD3~-CD19~+and CD19~+CD23~+in patients with active s JIA were significantly different from those in the control group(P<0.05).There were also differences in CD3~-CD16~+CD56~+counts between the two groups(P<0.05).There were significant differences in Ig A,Ig M,complement C3and C4 between patients with active s JIA and the control group(P<0.05).6.Peripheral blood leucocyte,C-reactive protein,erythrocyte sedimentation rate,aspartate aminotransferase and serum triglyceride both improved after treatment for 2 weeks and had significant difference before treatment(all P<0.05).7.In 49 cases of s JIA without MAS,the average follow-up time was 38.14±28.59 months.There were 13 cases(26.53%)achieved clinical remission off medication(CR),12 cases(24.49%)achieved In clinical remission on medication(C RM),4 cases(8.16%)achieved partial remission,7 cases(14.28%)relapsed during drug reduction,and 3 cases(6.12%)relapsed after drug withdrawal.There were 10 cases(20.41%)failed to follow up and no deaths occurred.8.After 10 cases of s JIA complicated with MAS were treated with GC,cyclosporine and other drugs,there were 5 cases of remission,3 cases of automatic discharge,and 2 cases of death.Conclusion:1.Arthritis in some s JIA patients is not obvious in the early stage of the disease.Early diagnosis can be assisted by B-ultrasonography,MRI,and other imaging studies.2.Active s JIA patients may have abnormal cellular and humoral immunity.3.After s JIA patients achieved clinical inactivity after initial treatment,most patients reached clinical inactivity.However,the proportion of patients who achieved clinical remission without medication was low.For the refractory s JIA,it is recommended to add biological agents as soon as possible.4.Early identification of MAS through timely monitoring of laboratory-related changes in sensitive indicators,and timely treatment.