Fink C W
University of Texas Southwestern Medical Center, Dallas.
Recenti Prog Med. 1991 Oct;82(10):552-60.
The author's classification of juvenile arthritis (JA) differs from most by utilizing both the type of onset and the disease course separated into individual subgroups. The clinical aspects of each are described in detail, along with the special tests and studies to be done to differentiate them. Particular attention is given to the differences between the four subgroups of the pauciarticular onset group. There are different genetic factors for each subgroup and new data on HLA typing utilizing DNA techniques may be helpful in the prognosis of the disease course. The therapy of JA begins with non-steroidal anti-inflammatory drugs, continues with second-line drugs such as gold and penicillamine, and finally leads to the use of immunosuppressive agents. The range of doses, the maximal dose, and the frequency of administration is given for each medication. The long-term prognosis is generally good, with a low death rate, primarily seen in the systemic onset patients. The causes of death vary around the world. Prognosis for continued joint activity and joint function is determined significantly by the type of onset and is worse in the rheumatoid factor positive polyarticular onset group.
作者对青少年关节炎（JA）的分类与大多数分类方法不同，它同时依据发病类型和病程将其分为不同的亚组。文中详细描述了每个亚组的临床特征，以及用于鉴别它们的特殊检查和研究。尤其关注少关节起病组四个亚组之间的差异。每个亚组都有不同的遗传因素，利用DNA技术进行HLA分型的新数据可能有助于疾病病程的预后评估。JA的治疗首先使用非甾体抗炎药，接着使用二线药物如金制剂和青霉胺，最后使用免疫抑制剂。文中给出了每种药物的剂量范围、最大剂量和给药频率。总体而言，长期预后良好，死亡率较低，主要见于全身起病的患者。世界各地的死亡原因各不相同。持续关节活动和关节功能的预后很大程度上取决于发病类型，在类风湿因子阳性多关节起病组中预后较差。
