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Diagnosis and follow-up of children referred to a rheumatic disease unit
Insights
Juvenile rheumatoid arthritis (JRA) is common in childhood rheumatic diseases. Most children with JRA achieve remission with minimal disability, though early onset or febrile presentation indicates a poorer prognosis.
Area of Science:
- Pediatrics
- Rheumatology
- Clinical Epidemiology
Background:
- Juvenile rheumatoid arthritis (JRA) is the leading rheumatic condition in children.
- Distinguishing JRA from other childhood conditions is crucial for appropriate management.
- Understanding prognostic factors aids in predicting disease course and outcomes.
Purpose of the Study:
- To determine the prevalence of JRA in children referred to a rheumatic disease unit.
- To assess the long-term outcomes and remission rates in children diagnosed with JRA.
- To identify prognostic indicators associated with JRA severity and functional disability.
Main Methods:
- A 5-year survey of 292 children referred to a rheumatic disease unit.
- Diagnosis of JRA and other rheumatic conditions based on established criteria.
- Follow-up assessments to evaluate disease remission, functional status, and development of organic disease.
Main Results:
- Out of 292 children, 94 were diagnosed with JRA, while only three had rheumatic fever.
- Approximately 70% of JRA patients achieved remission with little to no functional impairment.
- Febrile onset and onset before age six were associated with worse prognoses compared to pauciarticular or polyarticular onset after age six.
Conclusions:
- JRA is the predominant rheumatic disease in childhood, with a high rate of remission and good functional outcomes.
- Early-onset JRA or JRA with febrile presentation are indicators of a less favorable prognosis.
- Careful evaluation is needed for children presenting with growing pains or psychogenic rheumatism to rule out underlying organic conditions like chondromalacia patellae.
Abstract:
Juvenile rheumatoid arthritis (JRA) has become the predominant rheumatic disease of childhood. In a survey of 292 children referred to a rheumatic disease unit over a 5-year period, 94 had JRA and only three had rheumatic fever. At follow-up, of the children with JRA, 70% were found to be in remission with little or no functional disability. Febrile onset of JRA or onset before six years of age were worse prognostic features than pauciarticular or polyarticular onset of occurrence after six years of age. Of 28 children who had either growing pains or psychogenic rheumatism, two were subsequently found to have chondromalacia patellae. None of the other children in this group for whom follow-up information was available had developed organic disease.