Glueck Dane, Gellman Harris
Department of Orthopaedic Surgery, University of Kentucky, Lexington, USA.
J Am Acad Orthop Surg. 2005 Jul-Aug;13(4):254-66. doi: 10.5435/00124635-200507000-00005.
Juvenile rheumatoid arthritis is a multifaceted disease. Average age of onset is 6 years, with peaks between 1 and 4 and between 9 and 14 years. Girls are affected more frequently than boys. Nonsteroidal anti-inflammatory drugs are the standard first line of therapy. Second-line therapy of antirheumatic drugs may be used early for progressive disease. Intra-articular corticosteroid injections should be considered to preserve joint mobility and muscle strength when medical treatment fails to control synovitis or when marked functional impairment exists. Historically, surgery has been a last resort, but in appropriate patients, it should be considered soon after failure of conservative management. However, when possible, reconstructive surgery should be delayed until completion of skeletal growth.
