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Clinico-immunological profile in juvenile rheumatoid arthritis--an Indian experience
V Seth1, S K Kabra, O P Semwal
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
This study analyzed 361 children with juvenile rheumatoid arthritis (JRA), detailing subtypes, clinical features, and immunological markers. Findings show varied presentation across JRA subtypes, with systemic onset featuring more extra-articular symptoms.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Clinical Medicine
Background:
- Juvenile rheumatoid arthritis (JRA) is a complex autoimmune condition affecting children.
- Understanding the clinico-immunological profile of JRA subtypes is crucial for diagnosis and management.
Purpose of the Study:
- To retrospectively analyze the clinico-immunological profile of 361 children diagnosed with juvenile rheumatoid arthritis (JRA).
- To describe the demographic characteristics, clinical manifestations, and immunological findings across different JRA subtypes.
Main Methods:
- Retrospective analysis of 361 pediatric patients diagnosed with JRA based on American Rheumatism Association criteria.
- Evaluation of demographic data, clinical features (onset, joint involvement, extra-articular manifestations), and immunological markers (Rheumatoid Factor, Antinuclear Antibody).
Main Results:
- The study identified three main JRA subtypes: systemic (24%), pauciarticular (30%), and polyarticular (46%).
- Systemic JRA predominantly showed extra-articular features like fever and rash, while pauci- and polyarticular JRA primarily involved joint inflammation.
- Rheumatoid Factor was present in 15% of polyarticular JRA cases, and less frequently in other subtypes. Antinuclear Antibody positivity was low.
Conclusions:
- The demographic profile and clinical trends in JRA subtypes align with existing literature on Caucasian populations, though specific feature frequencies may differ.
- JRA presents with diverse clinical and immunological characteristics that vary significantly among its subtypes, necessitating tailored diagnostic and therapeutic approaches.
Abstract:
From a Pediatric Rheumatology Clinic 361 children diagnosed as juvenile rheumatoid arthritis (JRA) according to American Rheumatism Association-JRA criteria were studied retrospectively for their clinico-immunological profile. The mean age of onset in systemic, pauciarticular and polyarticular onset, JRA subtypes were 5.2, 6.8 and 7.2 years respectively. There was male preponderance in systemic and pauciarticular JRA. In seropositive polyarticular JRA, girls outnumbered boys. The frequency of occurrence of systemic, pauciarticular and polyarticular disease was 87 (24%), 108 (30%) and 166 (46%) respectively. The systemic onset disease was dominated by extra-articular manifestations in terms of fever (100%), rash (57%), hepatomegaly (51%) and lymphadenopathy (25%). The pauci- and polyarticular illnesses were commonly dominated by joint involvement, morning stiffness, and in few patients, by extra-articular manifestations also. The joints were involved symmetrically. Most commonly involved joints in order of decreasing frequency were knee, ankle, wrist and elbow in all the subtypes. Anemia and leucocytosis were observed in majority with higher frequency in systemic onset JRA. The rheumatoid factor (RF) was present in 15% of polyarticular JRA. RF was also present in 7 and 9% of patients with pauciarticular and systemic subtypes respectively. The antinuclear antibody was positive in only 3 out of 66 patients in whom the test was carried out. The demographic profile and trends in clinical features were similar to the studies reported on caucasian population with difference in the actual frequency of various clinical features.