Orthopaedic management of juvenile chronic arthritis (JCA)

Juvenile chronic arthritis is resulting in joint destruction and frequently also in growth disturbances. In less than 50% pain is the cause of functional disability. It is important for rheumasurgeons to differentiate between the three main types of JCA because of the different prognosis. It is also necessary to realize the involvement of all connective tissue and the multiple organ affections in this disease, especially the kidney-function and the hematopoietic system. The natural course of the disease is characterized by fluctuations between remissions and exacerbations, more irregularly than in the adult type of Rh.A. The good results of rheumasurgery are highly dependent on an interdisciplinary combined unit, preferably working "on the same floor" in daily cooperation. Special training in rheumasurgical operative technique is necessary. Prophylactic measures against joint contractures is of great importance and should be common knowledge of all members of the therapeutic team. During a period of 13 years 528 synovectomies were performed. In a controlled study of open knee-synovectomies, recurrence of the inflammation was rarely seen when a radical early synovectomy had been performed. The centralized unit with well experienced staff, who master the problems of anesthesia, medication, intraoperative blood-transfusion and physiotherapy pre- and post-operatively, may obtain good results in the management of this difficult disease.