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Juvenile rheumatoid arthritis, juvenile chronic arthritis, and juvenile spondyloarthropathies

B M Ansell1

  • 1Consulting Rooms, Windsor, UK.

Current Opinion in Rheumatology
|October 1, 1992
PubMed

Insights

Immunogenetics reveal diverse chronic childhood arthritis types. Early-onset pauciarticular disease links to specific HLA types, while methotrexate effectively manages polyarthritis in juvenile rheumatoid arthritis.

Area of Science:

  • Pediatric Rheumatology
  • Immunogenetics
  • Clinical Trial Analysis

Background:

  • Chronic arthritis in children exhibits significant heterogeneity.
  • Specific human leukocyte antigen (HLA) types, including DRw13-DRw18 and DQw6-DQw18, are associated with persistent pauciarticular disease in early-onset pediatric arthritis.
  • DPw2 is identified as an additional susceptibility factor in this subgroup.

Purpose of the Study:

  • To explore the immunogenetic basis of chronic childhood arthritis heterogeneity.
  • To evaluate the efficacy of methotrexate in managing juvenile rheumatoid arthritis (JRA).
  • To review current therapeutic strategies for pediatric arthritis, including immunogenetics and pharmacotherapy.

Main Methods:

  • Analysis of immunogenetic markers (HLA typing) in children with chronic arthritis.
  • Review of clinical studies on methotrexate efficacy in JRA, comparing different doses and placebo.
  • Examination of treatment outcomes for sulfasalazine and corticosteroid therapies (intra-articular, deflazacort, intravenous methylprednisone).

Main Results:

  • Specific HLA associations (DRw13-DRw18, DQw6-DQw18, DPw2) identified for persistent pauciarticular JRA.
  • Moderate-dose methotrexate demonstrated superiority over lower doses and placebo in controlling polyarthritis in JRA.
  • Methotrexate may be particularly beneficial for polyarthritis following a pauciarticular onset.
  • Intra-articular corticosteroids are highlighted for pauciarticular disease; deflazacort shows potential calcium-sparing effects; IV methylprednisone considered for severe cases.

Conclusions:

  • Immunogenetics play a crucial role in understanding the heterogeneity of chronic childhood arthritis.
  • Methotrexate is an effective treatment for polyarticular JRA, especially for those with prior pauciarticular involvement.
  • Further standardization of diagnostic criteria for juvenile spondyloarthropathy and psoriatic arthritis is needed, with HLA-B27 being a potential marker for a subset.

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