J Korean Rheum Assoc.  2007 Dec;14(4):331-339.

Clinical Features and Course of Systemic Onset Juvenile Rheumatoid Arthritis

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, The Hospital for Rheumatic Disease, Hanyang University College of Medicine, Seoul, Korea. dhyoo@hanyang.ac.kr

Abstract


OBJECTIVE
Juvenile rheumatoid arthritis (JRA) is classified as polyarticular, oligoarticular, and systemic onset type by clinical symptoms presented during first six months. This study was performed to investigate the clinical features and course of systemic onset JRA.
METHODS
We performed a retrospective study for patients who were diagnosed as JRA between March 2000 and March 2006 according to the JRA criteria of the International League of Association for Rheumatology (ILAR).
RESULTS
Of the 216 JRA patients, 33 patients (11 male/ 22 female) were systemic onset type. Because of insufficient data, 6 patients were excluded. Chief complaints at the time of diagnosis were fever (81.5%) and arthralgia (77.7%). During the disease course, all patients manifested fever and arthritis, rash (59.2%) and splenomegaly (22.2%) also occurred. Most patients had symmetric (81.5%) arthritis, and involved more than five joints (59.3%) including knee and wrist. Anemia, leukocytosis, and thrombocytosis were common laboratory abnormalities. Almost all patients had elevated level of C-reactive protein and erythrocyte sediment rate. Some patients had positive results about immunologic marker such as rheumatoid factor (3.8%), antinuclear antibody (57.7%), and antiperinuclear factor (9.5%). Therapeutic regimens included glucocorticoids (88.9%), nonsteroidal anti-inflammatory drugs (81.5%), methotrexate (81.5%), and hydroxychloroquine (55.6%). Biologic agents were applied in 5 patients, and 3 showed improvement of disease activity. Combination therapy was introduced in 18.5% of patients, and 63% of patients still required medications.
CONCLUSION
In Korea, systemic onset JRA patients had variable clinical manifestations and chronic course of disease, which often extended into adulthood.

Keyword

Juvenile rheumatoid arthritis; Systemic onset

MeSH Terms

Anemia
Antibodies, Antinuclear
Arthralgia
Arthritis
Arthritis, Juvenile*
Biological Factors
Biomarkers
C-Reactive Protein
Diagnosis
Erythrocytes
Exanthema
Fever
Glucocorticoids
Humans
Hydroxychloroquine
Joints
Knee
Korea
Leukocytosis
Methotrexate
Retrospective Studies
Rheumatoid Factor
Rheumatology
Splenomegaly
Thrombocytosis
Wrist
Antibodies, Antinuclear
Biological Factors
C-Reactive Protein
Glucocorticoids
Hydroxychloroquine
Methotrexate
Rheumatoid Factor
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