Juvenile Idiopathic Arthritis in a Tertiary Rheumatology Clinic
DOI:
https://doi.org/10.30442/ahr.0401-1-08Keywords:
Juvenile Idiopathic Arthritis, Rheumatologyy Clinic, Rheumatic diseaseAbstract
Background: Juvenile Idiopathic Arthritis (JIA) is one of the common chronic diseases in childhood. The inflammatory process in the joint is triggered by pro-inflammatory cytokines. The treatment is directed at alleviation of pain, inhibition of disease activity and preservation of range of motion.
Objectives: To describe the spectrum of clinical presentations, laboratory parameters and drug therapy among patients with Juvenile Idiopathic Arthritis seen at a Tertiary Health Centre.
Methods: All the patients who fulfilled the classification criteria of the International League of Associations for Rheumatology for JIA between July 2012 and June 2016 were included in the study. The clinical features, results of laboratory investigations and the treatment received were recorded.
Results: A total of 1910 patients were seen at the Out-Patient Rheumatology Clinic over the 4-year period but only 18 case files of patients with JIA (0.95% of total) were retrieved. There were 13 females and 5 males with a female-to-male ratio of 2.6:1. The age range was 8-15 years with a mean of 10.3 ± 2.1 years. The duration of symptoms prior to presentation ranged between 2 years and 7 years with a mean of 4.2 ± 1.3 years. Polyarticular presentation was observed among 61.1% (11/18), pauciarticular in 27.8% (5/18) and systemic in 11.1% (2/18). Fever was uniformly seen among the patients with systemic onset, while fever and joint swelling were the common presentations in the other groups. Knee and ankle joints were most commonly affected. Erythrocyte Sedimentation Rate was elevated in 88.9% of the patients. Methotrexate was used in 61.1% and combination therapy was used as necessary.
Conclusion: JIA is relatively uncommon in the setting of study. Polyarthritis form of JIA was the commonest type and response to steroid was uniformly good. Early recognition of the subtypes of JIA will enhance effective management of cases.
References
2. Petty RE, Southwood TR, Baum J, Bhettay, E, Glass DN, Manners P et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol 1998; 25: 1991-1994.
3. Woo P. Cytokines and juvenile idiopathic arthritis. Curr Rheumatol Rep 2002; 4: 452–457.
4. Rooney M, Varsani H, Martin K, Lombard PR, Dayer JM, WooP. Tumour necrosis factor alpha and its soluble receptors in juvenile chronic arthritis. Rheumatology (Oxford) 2000; 39: 432–438.
5. Weiss JE, Ilowite NT. Juvenile idiopathic arthritis. Pediatr Clin N Am 2005; 52: 413–442.
6. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390–392.
7. Singh-Grewal D, Schneider R, Bayer N, Feldman BM. Predictors of disease course and remission in systemic juvenile idiopathic arthritis: significance of early clinical and laboratory features. Arthritis Rheum 2006; 54: 1595–1601.
8. Martini A. Systemic juvenile idiopathic arthritis. Autoimmun Rev 2012; 12: 56–59.
9. Bennett TD, Fluchel M, Hersh AO, Hayward KN, Hersh AL, Brogan TV, et al. Macrophage activation syndrome in children with systemic lupus erythematosus and children with juvenile idiopathic arthritis. Arthritis Rheum 2012; 64: 4135–4142.
10. Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet 2011; 377:2138-2149.
11. Adelowo OO, Umar A. Juvenile idiopathic arthritis among Nigerians: a case study. Clin Rheumatol 2010; 29: 757-761.
12. Olaosebikan BH, Adelowo OO, Animashaun BA, Akintayo RO. Spectrum of paediatric rheumatic diseases in Nigeria. Pediatr Rheumatol 2017; 15: 7-12.
13. Chipeta J, Njobvu P , Wa-Somwe S , Chintu C , McGill PE, Bucala P. Clinical patterns of juvenile idiopathic arthritis in Zambia. Pediatr Rheumatol 2013; 11: 33-38.
14. Ringold S, Weiss PF, Beukelman T, DeWitt EM, Ilowite NT, Kimura Y et al 2013 Update of the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis. Arthritis and Rheumatism 2013; 65: 2499–2512
15. Nihal Gunatillaka KA, Kelum de Silva MK. Juvenile idiopathic arthritis: an observational study. Sri Lanka J Child Health 2007; 36: 96-101.
16. Nighat MA, Sumera FR, Saeed A. Pattern of juvenile rheumatoid arthritis seen in 91 patients, presenting to an urban rheumatology clinic in Pakistan. Proceeding Sheikh Zaid Postgrad Med Inst 2005; 19: 47-50.
17. Aggarwal A, Aggarwal V, Danda D. Outcome in juvenile rheumatoid arthritis in India. Indian Pediatr 2004; 41: 180-184.
18. Nandi M, Ganguli SK, Mondal R, Ghosh A. Clinico-serological profile of juvenile idiopathic arthritis. Indian Pediatr 2009; 46: 640-641.
19. Bahabri S, Al-Sewairi W, Al-Mazyad A, Karrar A, Al-Ballaa S, El-Ramahai K, et al. Juvenile rheumatoid arthritis: the Saudi experience. Ann Saudi Med 1997; 17: 413-418.
20. Fujikawa S, Okuni M. Clinical analysis of 570 cases with juvenile rheumatoid arthritis: results of a nationwide retrospective survey in Japan. Acta Paediatr Jpn 1997; 39: 245-249.
21. Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis why does it vary so much? J Rheumatol 2002; 29: 1520-1530.
22. Pruunsild C, Uibo K, Liivamägi H, Tarraste S, Talvik T, Pelkonen P. Incidence of juvenile rheumatoid arthritis in children in Estonia:a prospective population-based study. Scand J Rheumatol 2007; 36: 7-13.
23. Singh S, Salaria M, Kumar L, Minz R, Datta U, Sehgal S. Clinicoimmunological profile of juvenile rheumatoid arthritis at Chandigarh. Indian Pediatr 1999; 36: 449-454.
24. Cassidy JT, Pretty RE, Laxer RM, Linsley CB, editors. Textbook of Paediatric Rheumatology. 5th ed. Philadelphia: Elsevier Saunders; 2005.
25. Wu EY, Van Mater HA, Rabinovich E. Rheumatic diseases of childhood. In: Kleigman RM, Stanton BF, Schor NF, editors. Nelson Textbook of Paediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011.p. 829-839.
26. Azam S, Dipti T, Rahman S. Prevalence and clinical pattern of juvenile idiopathic arthritis in a semi-urban area of Bangladesh. Int J Rheum Dis 2012; 15: 116-120.
27. SamiaNaz, AsmaMushtaq, SairaRehman, Attia Bari, AmnahMaqsud, Muhammad Zeeshan Khan. Juvenile Rheumatoid Arthritis. J Coll Phys Surg Pakistan 2013; 23: 409-412.
28. Seth V, Kabra SK, Semwal OP, Jain Y. Clinico-immunological profile in juvenile rheumatoid arthritis: an Indian experience. Indian J Pediatr 1996; 63: 293-300.
29. Porkodi R, Subramaniam R, Krishnamurthy V, Madhavan R, Parthiban M, Chandrasekaran AN. Pattern of rheumatic diseases in South India IV. Clinical profile of juvenile rheumatoid arthritis. J Assoc Phys India 1990; 38: 771-773.
30. SelvaagAM, Lien G, Sorskaar D, Vinje O, Forre O, Flato B. Early disease course and predictors of disability in juvenile rheumatoid arthritis and juvenile spondyloarthropathy: a 3-year prospective study. J Rheumatol 2005; 32: 1122-1130.
31. Ringold S, Seidel KD, Koepsell TD, Wallace CA. Inactive disease in polyarticular juvenile idiopathic arthritis: current patterns and associations. Rheumatol 2009; 48: 972-977.
32. Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis why does it vary so much? J Rheumatol 2002; 29: 1520-1530.
33. Kessler EA, Becker ML. Therapeutic advancements in juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2014; 28: 293-313.
Downloads
Published
Issue
Section
License
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.
