Juvenile rheumatoid arthritis and spondyloarthropathies

This paper reviews the current literature on the clinical aspects of juvenile rheumatoid arthritis (JRA) and the juvenile spondyloarthropathies. The classification of the juvenile arthritides remains controversial. A sibling pair registry established a role for genetic influences on the onset and course types of JRA. Even in the absence of steroid treatment, children with JRA demonstrated decreased bone mineral density and an impairment of linear growth. Magnetic resonance imaging was found to be helpful in detecting subtalar or sacroiliac involvement. Studies were published on the use of azathioprine, cyclosporine, and cyclopyhosphamide in the treatment of severe JRA. The lack of severe liver toxicity was shown in patients having received high total doses of methotrexate. An international agreement was reached on defining improvement in JRA. Several studies found an improved long-term outcome in patients with JRA or the juvenile spondyloarthropathies.