Yokota Shumpei
Department of Pediatrics, Yokohama City University School of Medicine.
Nihon Rinsho. 2007 Jul;65(7):1331-5.
Among the subtypes of juvenile idiopathic arthritis (JIA), systemic JIA and arthritic JIA are different each other from many points of view such as clinical symptoms and course, laboratory findings, and drug response. The diagnostic process and treatment strategy should be discussed upon each characteristics. The diagnosis of arthritic JIA depends on the physical examination to reveal arthritis in each joints, blood examinations, and X-ray and MRI examination. The primary treatment includes low-dose methotrexate pulse therapy, and about 70% of the affected children will be improved. Other 30 % of children will be the objectives for the biologic response modifiers such as etanercept and infliximab. For the diagnosis of systemic JIA, clinical symptoms and signs including spiking fever pattern, skin rash, and arthritis are the first to be recognized, and pediatrician needs to exclude other febrile disease such as infectious disease, leukemia, Castleman disease, and other rheumatic diseases. For the children with systemic JIA, corticosteroids have been the only effective agents. Recently, IL-1Ra was reported to be effective for these children. Moreover, tocilizumab, anti-IL-6 receptor monoclonal antiboby developed in Japan, was revealed to be effective and safe.
在幼年特发性关节炎（JIA）的亚型中，全身型JIA和关节炎型JIA在临床症状与病程、实验室检查结果以及药物反应等诸多方面均存在差异。应依据各自特点探讨诊断流程与治疗策略。关节炎型JIA的诊断依赖于体格检查以发现各关节的关节炎、血液检查以及X线和MRI检查。主要治疗方法包括低剂量甲氨蝶呤脉冲疗法，约70%的患病儿童病情会得到改善。另外30%的儿童将成为生物反应调节剂（如依那西普和英夫利昔单抗）的治疗对象。对于全身型JIA的诊断，首先要识别包括弛张热型、皮疹和关节炎在内的临床症状与体征，儿科医生需要排除其他发热性疾病，如传染病、白血病、Castleman病和其他风湿性疾病。对于全身型JIA患儿，皮质类固醇一直是唯一有效的药物。最近，有报道称IL - 1Ra对这些患儿有效。此外，在日本研发的抗IL - 6受体单克隆抗体托珠单抗被证实有效且安全。
