Rheumatoid Disease in Children

Data relative to 102 patients seen between 1940 and 1960 with infantile rheumatoid arthritis were analyzed. The systemic nature of the disease and variable early clinical picture make early diagnosis very difficult. Only 20% had articular symptoms at the onset. The youngest was aged 6 months and there was a greater incidence of onset in the first two years of life. Particular attention was paid to the site of original joint involvement as compared with the subsequent final joint pathology. Spindle fingers or swollen proximal interphalangeal joints appear late in the disease but are usually diagnostic of infantile rheumatoid arthritis. Diagnosis is essentially a clinical one; laboratory tests are of little diagnostic value. Prognosis is related to the age of onset, on institution of therapy, and systemic manifestations. Of these patients 50% were functionally normal at the time of follow-up, 25% had mild residual disability and 25% were severely crippled.