| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rheumatology 2001; 40: 1309-1312
© 2001 British Society for Rheumatology
Paediatric Rheumatology |
Guidelines for management of childhood arthritis
Paediatric Rheumatology/Series Editor: P. Woo
Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire PO6 3LY, UK
The following guidelines have been produced by members of the British Paediatric Rheumatology Group. They have been produced as a consensus of opinion in the UK and Ireland. Current practice varies considerably and the aim of this document is to give a broad view of current practice, to be shared with trainees and allied health professionals. The general aim of each treatment protocol is to achieve remission of symptoms and then reduce treatment.
Date for review December 2003.
Diagnosis
Peripheral joints
Avoid diagnosing arthritis in the absence of observed joint swelling.
Consider other causes of joint swelling, particularly if only one joint is involved.
Occasionally active arthritis can be present when the only signs are decreased range of movement and loss of function.
Axial skeleton including hips
Due to lack of observable swelling, diagnosis of inflammatory joint disease is more dependent on the presence of inflammatory symptoms (morning stiffness, pain relieved by activity), pain on active and passive movement, and limitation of movement, and places greater reliance on investigations to exclude other causes.
Classification of juvenile idiopathic arthritis [1]
Arthritis must consistently present for 6 or more weeks for which no other cause can be found in a child or young adult before the 16th birthday.
Subtypes
1. Oligoarticular-onset JIA
Fewer than five joints involved during the first 6 months of disease.
Persistent. Four or fewer total joints involved during the duration of follow-up.
Extended. More than four joints involved during the duration of follow-up.
|
2. Polyarticular-onset JIA
Five or more joints involved during the first 6 months of disease, usually involving small joints in a symmetrical distribution.
Rheumatoid factor-negative.
Rheumatoid factor-positive. Rheumatoid factor-positive on two occasions 2 months apart.
|
3. Systemic-onset JIA
Chronic arthritis associated with systemic features, including high spiking fever, transient episodic erythematous rash, lymphadenopathy and hepatosplenomegaly (systemic features often precede the arthritis).
|
4. Psoriatic arthritis
Chronic arthritis, usually with asymmetrical involvement of small and large joints, and either the development of psoriasis or other evidence of a psoriatic diathesis (two of the following: family history in a first-degree relative, nail pits or dactylitis).
5. Enthesitis-related arthritis
Previously known as juvenile spondylarthropathy. Chronic arthritis associated with enthesitis (inflammation at insertion of tendons, ligaments or fascia to bone) or with lower axial skeletal involvement. HLA B27 present or a family history of a first-degree relative with a HLA B27-related disease. A significant proportion of patients will develop sacro-iliitis as adults, but back and sacroiliac joint involvement is uncommon during childhood.
6. Unclassified
Any form of idiopathic chronic arthritis persisting for at least 6 weeks which either does not fit into the above categories or fits into more than one.
Note added in proof
Since submission of these Guidelines, triamcinolone hexacetonide has been withdrawn in some countries. Triamcinolone hexacetonide 1 mg is equivalent to triamcinolone acetonide 1 mg or methylprednisolone 2 mg.
References
- Petty RE, Southwood TR, Baum J et al. Revision of proposed classification criteria for juvenile idiopathic arthritis. Durban 1997. J Rheumatol1998;25:1991–4.[Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||