Prieur A M, Chèdeville G
Unité d'Immunologie, Hématologie et Rhumatologie Pédiatriques, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75743 Paris cedex 15, France.
Curr Rheumatol Rep. 2001 Oct;3(5):371-8. doi: 10.1007/s11926-996-0006-6.
Prognostic factors in juvenile arthritis are related to many variables that must be evaluated according to the different subtypes. The International League of Associations of Rheumatologists (ILAR) recently proposed six different categories referred to as the Durban criteria, under the eponym of juvenile idiopathic arthritis (JIA). The aim of this classification was to define homogeneous groups according to their clinical and biologic features. The prognostic factors were classified into the different categories of JIA. A poor outcome in the systemic form correlated with markers of disease activity, such as fever and polyarticular involvement, within the first 6 months. The risk of joint destruction in oligoarthritis correlated with the severity of arthritis within the first 2 years. Polyarthritis with positive rheumatoid factor is associated with marked disability in adulthood. In a group of psoriatic patients, the risk of developing sacroiliitis is higher in male and HLA-B27-positive patients. Patients with enthesitis-related arthritis with lower limb, knee, and tarsal involvement also are at greater risk of developing sacroiliitis. Chronic uveitis is a complication of JIA observed mainly in patients with oligoarthritis associated with positive antinuclear antibodies in serum. Secondary amyloidosis is observed mainly in children with systemic JIA. The long-term outcome must be discussed according to the various therapies. Corticosteroids contribute to growth retardation and osteoporosis, for which the use of human recombinant growth hormone and biphosphonates may be an option. Newer encouraging therapies such as anticytokines have been proposed for children with active disease. Autologous stem cell transplantation is being evaluated in some centers with promising results; however, it has a high rate of mortality. Further discussion regarding which patients should undergo autologous stem cell transplantation is needed, as is further discussion regarding the technical adaptations necessary.
青少年关节炎的预后因素与许多变量相关，必须根据不同亚型进行评估。国际风湿病联盟（ILAR）最近提出了六种不同的类别，即德班标准，以青少年特发性关节炎（JIA）命名。该分类的目的是根据临床和生物学特征定义同质组。预后因素被分类到JIA的不同类别中。全身型预后不良与疾病活动标志物相关，如最初6个月内的发热和多关节受累。少关节炎中关节破坏的风险与最初2年内关节炎的严重程度相关。类风湿因子阳性的多关节炎与成年期的明显残疾相关。在一组银屑病患者中，男性和HLA - B27阳性患者发生骶髂关节炎的风险更高。有下肢、膝关节和跗骨受累的附着点炎相关关节炎患者发生骶髂关节炎的风险也更高。慢性葡萄膜炎是JIA的一种并发症，主要见于血清抗核抗体阳性的少关节炎患者。继发性淀粉样变性主要见于全身型JIA患儿。必须根据各种治疗方法讨论长期预后。皮质类固醇会导致生长发育迟缓以及骨质疏松，对此可选择使用重组人生长激素和双膦酸盐。对于患有活动性疾病的儿童，已经提出了如抗细胞因子等更有前景的新疗法。一些中心正在评估自体干细胞移植，结果令人鼓舞；然而，其死亡率很高。需要进一步讨论哪些患者应接受自体干细胞移植，以及所需的技术调整。
