Rheumatoid arthritis, juvenile

JRA Juvenile rheumatoid arthritis MS Mental status mitral stenosis musculoskeletal mul-... 

Thompson SD, Luyrink LK, Graham TB, et al. Chemokine receptor CCR4 on CD4+ T cells in juvenile rheumatoid arthritis synovial fluid defines a subset of cells with increased IL-4 IFN-gamma mRNA ratios. J Immunol 2001 166(11) 6899-6906. 

A. Muhlberg, C. Linz, E. Bern, L. Tucker, M. Ver-have, and R. Grand, Identifaction of nonsteroidal anti-inflammatory drug induced gastrointestinal injury in children with juvenile rheumatoid arthritis, J. Pediatr, 122, 647 (1993). 

Heijnen, C.J. et al., Functional oij-adrenergic receptors on leukocytes of patients with polyarticular juvenile rheumatoid arthritis, J. Neuroimmunol., 71, 223, 1996. 

Culy CR, Keating GM. Etanercept. An updated review of its use in rheumatoid arthritis, psoriatic arthritis and juvenile rheumatoid arthritis. Drugs 2002 62 2493-537. 

Children The efficacy of penicillamine in juvenile rheumatoid arthritis has not been established. 

Chiidren Mefenamic acid and meclofenamate are not recommended in children younger than 14 years of age. Indomethacin is not recommended in children 14 years of age and younger, except in circumstances that warrant the risk. Safety and efficacy of meloxicam has not been established in children younger than 18 years of age. Tolmetin and naproxen are the only agents labeled for juvenile rheumatoid arthritis. Safety and efficacy of tolmetin in infants younger than 2 years of age are not established. Safety and efficacy of other NSAIDs in children are not established. 

Juvenile rheumatoid arthritis (JRA enteric-coated tablets) n the treatment of pediatric patients 6 years of age or older with polyarticular-course JRA who have responded inadequately to salicylates or other NSAIDs. 

Sulfasalazine also is indicated for use in rheumatoid arthritis and juvenile rheumatoid arthritis. Refer to the monograph in the Biologic and Immunologic Agents chapter. 

Children Patients as young as 6 months of age have received Sandimmune v / Vr no unusual adverse effects. Transplant recipients as young as 1 year of age have received Neoral or Gengrraf with no unusual adverse effects. The safety and efficacy of Neoral or Gengraf treatment in children younger than 18 years of age with juvenile rheumatoid arthritis or psoriasis have not been established. 

Polyarticular-course juvenile rheumatoid arthritis (JRA) Management of children with active polyarticular-course JRA who have had an insufficient therapeutic response to, or are intolerant of, an adequate trial of first-line therapy including full-dose NSAIDs. 

Polyarticular-course juvenile rheumatoid arthritis (JRA) For reducing signs and symptoms of moderately to severely active polyarticular-course JRA in patients who have had an inadequate response to at least 1 disease-modifying antirheumatic drug (DMARD). 

Children Safety and efficacy in patients with juvenile rheumatoid arthritis and in pediatric patients with Crohn disease have not been established. 

ITP idiopathic thrombocytopenic purpura IV intravenous IVP intravenous push JRA juvenile rheumatoid arthritis K/K potassium KVO ke vein open L/d liters per day LA long acting LDL low-density hpoprotein LFT liver function test LH leuteinizing hormone LHRH luteinizing hormone releasing hormone... 

Etanercept is a recombinant human soluble tumor necrosis factor-alpha (TNFo ) receptor fusion protein that binds to TNFo and decreases its role in disorders involving excess inflammation. It is approved for subcutaneous use in the treatment of patients with moderate to severe active rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing arthritis and plaque psoriasis. To the adverse reactions mentioned for infliximab, rare reports of congestive heart failure should be added. 

New indication Polyarticular-course juvenile rheumatoid arthritis... 

H. Other considerations Enbrel has been designated an orphan product for use in the treatment of juvenile rheumatoid arthritis and Wegener s granulomatosis. 

Indomethacin was particularly popular for gout and ankylosing spondylitis. In addition, it has been used to accelerate closure of patent ductus arteriosus. Indomethacin has been tried in numerous small or uncontrolled trials for many other conditions, including Sweet s syndrome, juvenile rheumatoid arthritis, pleurisy, nephrotic syndrome, diabetes insipidus, urticarial vasculitis, postepisiotomy pain, and prophylaxis of heterotopic ossification in arthroplasty. 

Etanercept is a dimeric fusion protein composed of human IgGj constant regions (CH2, CH3, and hinge, but not CH ) fused to the TNF receptor. Etanercept binds to both TNF- and TNF-3 and appears to have effects similar to that of infliximab, ie, inhibition of TNF-K-mediated inflammation, but its half-life is shorter due to its physical form (fusion protein) and the route of injection (subcutaneously, twice weekly). Etanercept is approved for adult rheumatoid arthritis, polyarticular-course juvenile rheumatoid arthritis, and psoriatic arthritis. It may be used in combination with methotrexate. 

Clinical use Tolmetin (Brogden et al., 1978b) is a nonsteroidal anti-inflammatory drug used for the treatment of mild to moderate pain states in musculoskeletal, soft tissue and joint disorders such as rheumatoid arthritis, osteoarthritis and gout as well as juvenile rheumatoid arthritis. 

Etanercept is a genetically engineered protein that is soluble TNF-a receptor. Its molecular weight is 75kDa. It binds to TNF-a. It is used for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Structurally, two TNF-a receptors are linked to an Fc portion of an... 

Kimura Y, Fieldston E, Devries-Vandervlugt B, Li S, Imundo L. High dose, alternate day corticosteroids for systemic onset juvenile rheumatoid arthritis. J Rheumatol 2000 27(8) 2018-24. 

Type 1 diabetes mellitus occurred after 5 months treatment with etanercept for juvenile rheumatoid arthritis in a 7-year-old girl (389). Antiglutamic acid decarboxylase antibodies were positive both before and during treatment, suggesting that etanercept may have prematurely triggered an underlying disease. 

Bloom BJ. Development of diabetes mellitus during etanercept therapy in a child with systemic-onset juvenile rheumatoid arthritis. Arthritis Rheum 2000 43(ll) 2606-8. 

Specific criteria for the diagnosis of rheumatoid arthritis in adults are listed in Table 16-1. In addition to the adult form of this disease, there is also a form of arthritis that occurs in children known commonly as juvenile rheumatoid arthritis, or by the more recent term juvenile idiopathic arthritis (JIA). Juvenile arthritis differs from the adult form of this disease—the age of onset (younger than 16 years) and other criteria help to differentiate these two types of rheumatoid joint disease.69,109 Drug treatment of adult and juvenile rheumatoid arthritis is fairly similar, however, with the exception that children may not respond as well to certain medications (e.g., hydroxychloroquine, gold compounds, penicillamine) compared to adults.79 80 Consequently, in this chapter most of the discussion of the management of rheumatoid arthritis is directed toward the adult form. 

Gold is effective for active rheumatoid arthritis and has been shown to slow radiologic progression of the disease. It has also been used in Sjogren s syndrome and juvenile rheumatoid arthritis, while use in psoriatic arthritis is controversial. In Japan, gold is used to treat asthma. The oral form of gold is effective in rheumatoid arthritis, but it appears less effective than the intramuscular formulation and is generally felt to have only modest effects. 

F7. Fong, S., Miller, J. J., Moore, T. L., Tsoukas, C. D., Vaughan, J. H., and Carson, D. A., Frequencies of Epstein-Barr virus-inducible IgM anti-IgG B lymphocytes in normal children and children with juvenile rheumatoid arthritis. Arthritis Rheum. 25, 959-965 (1982). 

R6. Rossen, R. D., Brewer, E. J, Person, D. A., Templeton, J. W., and Lidsky, M. D., Circulating immune complexes and antinuclear antibodies in juvenile rheumatoid arthritis. Arthritis Rheum. 20, 1485-1490 (1977). 

Varni, J. W., Wilcox, K. T., and Hanson, V. (1988). Mediating effects of family social support on child psychological adjustment in juvenile rheumatoid arthritis. Health Psychology 7(5), 421-431. 

Tolmetin and nabumetone Tolmetin [TOLL me tin] and nabume-tone [na BYOO me tone] are as potent as aspirin in treating adult or juvenile rheumatoid arthritis or osteoarthritis, but may have fewer adverse effects. 

Enbrel Etanercept Amgen 11/1998 Moderately to severely active rheumatoid arthritis/ polyarticular course juvenile rheumatoid arthritis/ psoriasis CHO... 

Juvenile rheumatoid arthritis is termed Still s disease (G.F. Still, 1897). The disease begins in the finger joints and attacks the large joints and the cervical vertebral column in progressive steps. Lymphadenopathy is also present. The liver and spleen may be considerably enlarged. Despite this, there are only very few histological findings, such as periportal lymphocytic infiltrates and Kupffer cell proliferations. (103)... 

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