Early recognition and diagnosis of Lyme disease can prevent long-term complications.
Approximately 30% of children with juvenile rheumatoid arthritis will have progressive arthritis into adulthood.
There are three phases to Kawasaki disease, which can last 6-8 weeks after onset of symptoms.
JUVENILE RHEUMATOID ARTHRITIS
Juvenile rheumatoid arthritis (JRA) is a chronic disease that affects 60,000 to 200,000 children in the United States. In 1997 the International League of Association for Rheumatology suggested renaming juvenile rheumatoid arthritis as juvenile idiopathic arthritis to encompass criteria for all classifications, but for this chapter we use JRA.
Chronic arthritis in children is thought to have both an environmental and a genetic component. Factors such as familial, seasonal, and ethnic differences account for some of the environmental factors. Certain human leukocyte antigen alleles are associated with disease occurrence from a genetic perspective. Although JRA is rarely life threatening, long-term outcomes for children are hard to predict.
Although JRA is rarely life threatening, long-term outcomes for children are hard to predict.
Pathophysiology
Current literature suggests that T cells are activated and cause development of antigen-antibody complexes that release cytokines into specific organs such as joints and skin. JRA is characterized by inflammation of the synovium with joint effusion and eventual destruction of the articular cartilage lasting 6 weeks or longer. Classification depends on the number of joints involved and other coexisting symptoms. Joint swelling, stiffness, and restriction of motion usually are present. The three types of JRA are systemic, pauciarticular, and polyarticular (Table 54-1).
The three types of JRA are systemic, pauciarticular, and polyarticular.
Treatment
There is no cure for JRA. However, in 85% of the cases disease activity diminishes with age and ceases by puberty. Problems later in life are usually associated with residual joint damage. Treatment for JRA consists of controlling the pain, preserving joint range of motion, minimizing the effects of inflammation, and promoting optimal growth and development. Several medications are used to treat JRA:
Nonsteroidal anti-inflammatory drugs
Slower acting antirheumatic drugs
Corticosteroids
Etanercept or Remicade (a new biological agent)
Cytotoxic agents
Other treatment modalities are as follows:
Physical therapy
Splints
Moist heat
Swimming
Table 54-1 Characteristics of Juvenile Rheumatoid Arthritis Related to Type of Onset
Systemic (Variable Joint Involvement)
Pauciarticular (Types I and II) ( < 4 Joints)
Polyarticular ( > 5 Joints)
Percent
30%
45%
25%
Incidence
1-3
Age,
8-10
Type I: < 10
> 10
Sex
1.5:1 (f:m)
Almost all female
Type II: > 10
1:9 (f:m)
Mostly female
Laboratory findings
Anemia, elevated ESR, ANA rarely (+), leukocytosis, RF negative
JUVENILE RHEUMATOID ARTHRITIS
Although JRA is rarely life threatening, long-term outcomes for children are hard to predict.
The three types of JRA are systemic, pauciarticular, and polyarticular.
