Bowyer Suzanne L, Roettcher Philip A, Higgins Gloria C, Adams Barbara, Myers Linda K, Wallace Carol, Rennebohm Robert, Moore Terry L, Pepmueller Peri H, Spencer Charles, Wagner-Weiner Linda, Rabinovich Egla, Passo Murray, Lovell Daniel J, McCurdy Deborah, Zemel Lawrence, Schikler Kenneth N, Szer Ilona, Kurtin Paul, Lindsley Carol
Pediatric Rheumatology Divisions, Indiana University, Indianapolis, Indiana, USA.
J Rheumatol. 2003 Feb;30(2):394-400.
To describe the health and functional status of children with juvenile rheumatoid arthritis (JRA) diagnosed in the early 1990s.
Patients were obtained from the Pediatric Rheumatology Disease Registry, a database of patients seen in pediatric rheumatology centers across the United States. Questionnaires designed to be filled out after retrospective chart review were sent to pediatric rheumatologists caring for children diagnosed with JRA between 1992 and 1997.
We studied 703 patients -- 376 with pauciarticular onset (pauci), 232 with polyarticular onset (poly), and 95 with systemic onset JRA (systemic). At 1 year after diagnosis, half of the pauci and systemic patients no longer required medication, compared to 78% of the poly patients; 98% of the patients functioned in Steinbrocker classes I and II. Six percent of pauci, 27% of poly, and 11% of systemic patients had limitations in school function. Nearly 1/3 of poly patients already had joint space narrowing on radiograph. By 5 years after diagnosis, all pauci, 88% of poly, and 70% of systemic patients were in Steinbrocker classes I and II; but 6% of pauci, 28% of poly, and 44% of systemic patients had limitations in school function. Nearly 2/3 of poly and systemic patients had joint space narrowing.
In these children treated prior to the era of biologic therapy, at 5 years after onset, > 25% of poly and nearly half of systemic patients had functional limitations that required modifications in their school schedule. Radiographically evident joint space damage was seen within a year of onset in poly patients, and by 5 years 2/3 of poly and systemic patients had damage.
描述20世纪90年代初诊断的幼年类风湿性关节炎（JRA）患儿的健康和功能状况。
患者来自儿科风湿病疾病登记处，这是一个美国儿科风湿病中心诊治患者的数据库。在回顾性查阅病历后设计的问卷被发送给1992年至1997年间诊治JRA患儿的儿科风湿病学家。
我们研究了703例患者——376例少关节起病型（少关节型）、232例多关节起病型（多关节型）和95例全身起病型JRA（全身型）。诊断后1年，少关节型和全身型患者中有一半不再需要药物治疗，而多关节型患者为78%；98%的患者功能处于斯坦布鲁克分级I级和II级。少关节型患者中有6%、多关节型患者中有27%、全身型患者中有11%存在学校功能受限。近1/3的多关节型患者在X线片上已有关节间隙变窄。诊断后5年，所有少关节型、88%的多关节型和70%的全身型患者功能处于斯坦布鲁克分级I级和II级；但少关节型患者中有6%、多关节型患者中有28%、全身型患者中有44%存在学校功能受限。近2/3的多关节型和全身型患者有关节间隙变窄。
在这些生物治疗时代之前接受治疗的儿童中，发病5年后，超过25%的多关节型和近一半的全身型患者存在功能受限，需要调整学校课程安排。多关节型患者在发病1年内可见X线片上明显的关节间隙损害，到5年时，2/3的多关节型和全身型患者出现损害。
