Orthopedic overview of juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis can be classified into three forms by the extent of early involvement: (1) pauciarticular, (2) polyarticular, and (3) systemic. When this disease, in which remission is common, is properly diagnosed and appropriately treated by physical therapy, occupational therapy, drug therapy, and surgical treatment, a good clinical result can usually be expected. Only 16 of 124 children had severe persistent impairment because of the disease in one recent study;18 this number may be high, since mild cases may be unrecognized or not be referred to the study clinic. However, efforts should be directed to reducing this number of severely impaired children -- in the short run by better techniques of reconstructive surgery and in the long run by a better understanding, through research into the etiology and pathogenesis of the disease adequate to prevent or significantly alter its course. The disease may be caused by a treatable occult infective agent and may respond to an approach similar to that for rheumatic fever, which no longer fills the wards of our children's hospitals as it once did.