Boros Christina, Whitehead Ben
Discipline of Paediatrics, The Children, Youth and Women's Health Service, University of Adelaide, South Australia.
Aust Fam Physician. 2010 Sep;39(9):630-6.
Juvenile idiopathic arthritis is the most common rheumatic disease in childhood, occurring in approximately 1:500 children. Despite a recent expansion in treatment options and improvement of outcomes, significant morbidity still occurs.
This article outlines the clinical manifestations, assessment, detection of complications, treatment options and monitoring requirements, with the aid of guidelines recently published by The Royal Australian College of General Practitioners, which provide practical support for general practitioners to ensure best practice care and to prevent lifelong disability in patients with juvenile idiopathic arthritis.
General practice plays an important role in the early detection, initial management and ongoing monitoring of children with juvenile idiopathic arthritis. Early detection involves understanding the classification framework for subtypes of juvenile idiopathic arthritis, and being aware of the clinical manifestations and how to look for them, through history, examination and appropriate investigation. The major extra-articular manifestations of juvenile idiopathic arthritis are uveitis and growth disturbance. Treatment options include nonsteroidal anti-inflammatory drugs, methotrexate, biologic agents, and corticosteroids. Management using a multidisciplinary approach can prevent long term sequelae. Unfortunately, approximately 50% of children will have active disease as adults.
幼年特发性关节炎是儿童期最常见的风湿性疾病，发病率约为1/500。尽管近年来治疗选择有所增加且治疗效果有所改善，但仍会出现严重的发病情况。
本文借助澳大利亚皇家全科医师学院最近发布的指南，概述幼年特发性关节炎的临床表现、评估、并发症检测、治疗选择及监测要求，这些指南为全科医生提供实际支持，以确保为幼年特发性关节炎患者提供最佳治疗并预防终身残疾。
全科医疗在幼年特发性关节炎患儿的早期发现、初始管理及持续监测中发挥着重要作用。早期发现包括了解幼年特发性关节炎亚型的分类框架，通过病史、检查及适当的检查手段，知晓其临床表现及如何进行排查。幼年特发性关节炎主要的关节外表现为葡萄膜炎和生长发育障碍。治疗选择包括非甾体类抗炎药、甲氨蝶呤、生物制剂及皮质类固醇。采用多学科方法进行管理可预防长期后遗症。遗憾的是，约50%的儿童成年后仍会有活动性疾病。
