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2017 ; 34
(2
): 90-101
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Juvenile Idiopathic Arthritis
#MMPMID28418334
Barut K
; Adrovic A
; ?ahin S
; Kasapçopur Ö
Balkan Med J
2017[Apr]; 34
(2
): 90-101
PMID28418334
show ga
Juvenile idiopathic arthritis is the most common chronic rheumatic disease of
unknown aetiology in childhood and predominantly presents with peripheral
arthritis. The disease is divided into several subgroups, according to
demographic characteristics, clinical features, treatment modalities and disease
prognosis. Systemic juvenile idiopathic arthritis, which is one of the most
frequent disease subtypes, is characterized by recurrent fever and rash.
Oligoarticular juvenile idiopathic arthritis, common among young female patients,
is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis.
Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult
rheumatoid arthritis, is seen in less than 10% of paediatric patients.
Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific
for childhood, appears with widespread large- and small-joint involvement.
Enthesitis-related arthritis is a separate disease subtype, characterized by
enthesitis and asymmetric lower-extremity arthritis. This disease subtype
represents the childhood form of adult spondyloarthropathies, with human
leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton
involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash,
accompanied by arthritis, nail pitting and dactylitis. Disease complications can
vary from growth retardation and osteoporosis secondary to treatment and disease
activity, to life-threatening macrophage activation syndrome with multi-organ
insufficiency. With the advent of new therapeutics over the past 15 years, there
has been a marked improvement in juvenile idiopathic arthritis treatment and
long-term outcome, without any sequelae. The treatment of juvenile idiopathic
arthritis patients involves teamwork, including an experienced paediatric
rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist
and a physiotherapist. The primary goals of treatment are to eliminate active
disease, to normalize joint function, to preserve normal growth and to prevent
long-term joint damage. Timely and aggressive treatment is important to provide
early disease control. The first-line treatment includes disease-modifying
anti-rheumatic drugs (methotrexate, sulphasalazine, leflunomide) in combination
with corticosteroids, used in different dosages and routes (oral, intravenous,
intra-articular). Intra-articular application of steroids seems to be an
effective treatment modality, especially in monoarthritis. Biological agents
should be added in the treatment of unresponsive patients. Anti-tumour necrosis
factor agents (etanercept, infliximab, adalimumab), anti-interleukin-1 agents
(anakinra, canakinumab), anti- interleukin-6 agents (tocilizumab) and T-cell
regulatory agents (abatacept) have been shown to be safe and effective in
childhood patients. Recent studies reported sustained reduction in joint damage
with even complete clinical improvement in paediatric patients, compared to
previous data.
|Adolescent
[MESH]
|Adrenal Cortex Hormones/therapeutic use
[MESH]
|Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
[MESH]
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