Juvenile chronic arthritis

NSAIDs are groups of unrelated organic acids such as mefenamic acid, which have analgesic, antiinflammatory, and antipyretic activities. NSAIDs are used to relieve mild to moderate pain, raised temperature, and acute and chronic inflammatory disorders such as osteoarthritis, rheumatoid arthritis, juvenile chronic arthritis, and ankylosing spondylitis. NSAIDs are applied locally for the relief of muscular pain and are useful in ophthalmic preparations for inflammatory eye disorders.1-4 NSAIDs have been used to relieve pain, particularly in cancer patients, forming a cornerstone in pain management. NSAIDs also are used... 

The development of the intestinal microbiota needs to be characterized to define the composition that helps us to remain healthy. Specific aberrations in the intestinal microflora may predispose to disease. Such aberrations have been identified in allergic disease, including decreased numbers of bifidobacteria and an atypical composition of bifidobacterial microflora. Also, aberrations in Clostridium content and composition have been reported to be important. Similar predisposing factors may also exist in the case of microflora and both inflammatory gut diseases and rotavirus diarrhea. Microflora aberrations have also been reported in rheumatoid arthritis, juvenile chronic arthritis, ankylosing spondylitis, and irritable bowel syndrome patients. A thorough knowledge of the intestinal microflora composition will offer a basis for future probiotic development and the search for new strains for human use. Many diseases and their prevention can be linked to the microflora in the gut. 

American Pain Society. Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. New York American Pain Society 2002 43-74. 

Juvenile chronic arthritis is defined as a group of systemic inflammatory disorders affecting children below the age of 16 years. Pharmacotherapy is aimed to reduce pain and non-steroidal anti-inflammatory drugs are used. Ibuprofen is used at a dose of 30-40 mg/kg daily up to a maximum of 2.4 g. Other agents used include diclofenac at a dose of 1-3 mg/kg daily. 

Cyclosporine is approved for use in rheumatoid arthritis and retards the appearance of new bony erosions. Its usual dosage is 3-5 mg/kg/d divided into two doses. Anecdotal reports suggest that it may be useful in systemic lupus erythematosus, polymyositis and dermatomyositis, Wegener s granulomatosis, and juvenile chronic arthritis. 

Sulfasalazine is effective in rheumatoid arthritis and reduces radiologic disease progression. It has been used in juvenile chronic arthritis and in ankylosing spondylitis and its associated uveitis. The usual regimen is 2-3 g/d. 

Touati G, Prieur AM, Ruiz JC, Noel M, Czernichow P. Beneficial effects of one-year growth hormone administration to children with juvenile chronic arthritis on chronic steroid therapy. I. Effects on growth velocity and body 60. composition. J Clin Endocrinol Metab 1998 83(2) 403-9. 

Although the most common methotrexate dosing regimens for the treatment of rheumatoid arthritis are 15 or 17.5 mg weekly, there is an increased effect up to 30 or 35 mg weekly. The drug decreases the rate of appearance of new erosions. Evidence supports its use in juvenile chronic arthritis, and it has been used in psoriasis, psoriatic arthritis, polymyositis, dermatomyositis, Wegener s granulomatosis, giant cell arteritis, subacute lupus erythematosus, and vasculitis. 

The compound is indicated for the treatment of rheumatoid arthritis and decreases the rate of formation of new erosions. It is effective both as monotherapy and in combination with methotrexate. The usual dose is 40 mg every other week, though increased responses may be evident at higher dosages. Adalimumab is presently being tested in psoriasis, psoriatic arthritis, ankylosing spondylitis, and juvenile chronic arthritis. 

Fishman D, Faulds G, Jeffery R, Mohamed-Ali V, Yudkin JS, Humphries S, Woo P. The effect of novel polymorphisms in the interleukin-6 (IL-6) gene on IL-6 transcription and plasma IL-6 levels, and an association with systemic-onset juvenile chronic arthritis. J Clin Invest 1998 102 1369-1376. 

Pay S, Dine A, Simsek I, Can C, Erdem H. Sulfasalazine-induced angioimmunoblastic lymphadenopathy developing in a patient with juvenile chronic arthritis. Rheumatol Int 2000 20(l) 25-7. 

Experience in children with juvenile chronic arthritis or chronic inflammatory bowel disease has also accumulated, and the toxicity profile of azathioprine or mercaptopurine appears to be very similar to that previously found in the adult population (SEDA-21, 381) (SEDA-22, 410). 

Savolainen HA, Kautiainen H, Isomaki H, Aho K, Verronen P. Azathioprine in patients with juvenile chronic arthritis a longterm followup study. J Rheumatol 1997 24(12) 2444-50. 

Several studies have shown that in juvenile chronic arthritis auranofin gives rise to fewer adverse reactions than in... 

Juvenile chronic polyarthropathy (62) and reactive arthritis (63) have been attributed to hepatitis B vaccine. Erythema nodosum and polyarthritis occurred the day after Engerix-B vaccine administration (64). The authors referred to reports of three other cases of polyarthritis in the literature. 

Epplen C, Rumpf H, Albert E, et al. Immunoprinting excludes many potential susceptibihty genes as predisposing to early onset pauciarticular juvenile chronic arthritis except HLA class II and TNF. Eur J Immunogenet 1995 22 311-22. 

The clinical effects of Etanercept are comparable to those of Infliximab. One advantage of Etanercept is that it is given subcutaneously twice a week, whereas Infliximab is given by slow intravenous infusion every 4-8 weeks. Another advantage is that Etanercept also recognizes lymphotoxin, and this may account for its efficacy in juvenile chronic arthritis. Currently, D2E7, a fully human anti-TNF antibody, is being developed (Knoll). It appears to be effective in RA without the need for methotrexate cotreatment (575). 

TNF)-a - a highly effective approach to the treatment of chronic inflammatory illnesses. Originally approved for rheumatoid arthritis (approximately 5 million people globally suffer from rheumatoid arthritis), Enbrel has now gained approval for additional indications, including psoriatic arthritis, juvenile rheumatoid arthritis and ankylosing spondylitis. 

Arden, G.P. and Bywaters, E.G.L. (1978), in Surgical Management of Juvenile Chronic Poly Arthritis. Arden, G.P., Ansel, B.M. (eds). Academic Press, London, pp. 269-270. 

Lamer S, Sebag GH (2000) MRl and ultrasound in children with juvenile chronic arthritis. Eur J Radiol 33 85-93 Langer R (1987) Ultrasonic investigation of the hip in newborns in the diagnosis of congenital hip dislocation classification and results of a screening program. Skeletal Radiol 16 275-279... 

We have investigated the relationship between exposed galactose and GlcNAc on IgG in RA, juvenile chronic arthritis (JCA) and Sjogren s syndrome (SS) [43]. This... 

Psoriasis can occur in association with chronic juvenile arthritis as well as Reiter s syndrome. Some investigators have demonstrated a significant increase in prevalence in patients with human immunodeficiency virus infection.The pathogenesis of this relationship is imclear, but an immune recognition event may occm related to the HLA-B27 antigen. A large, retrospective, population-based study found that psoriatic arthritis is mild, imcom-mon, and not associated with a significant increase in mortality. 

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