Centre for Molecular and Cellular Intervention, Department of Paediatrics, University Medical Centre Utrecht, Netherlands.
Lancet. 2011 Jun 18;377(9783):2138-49. doi: 10.1016/S0140-6736(11)60244-4.
Juvenile idiopathic arthritis is a heterogeneous group of diseases characterised by arthritis of unknown origin with onset before age of 16 years. Pivotal studies in the past 5 years have led to substantial progress in various areas, ranging from disease classification to new treatments. Gene expression profiling studies have identified different immune mechanisms in distinct subtypes of the disease, and can help to redefine disease classification criteria. Moreover, immunological studies have shown that systemic juvenile idiopathic arthritis is an acquired autoinflammatory disease, and have led to successful studies of both interleukin-1 and interleukin-6 blockade. In other forms of the disease, synovial inflammation is the consequence of a disturbed balance between proinflammatory effector cells (such as T-helper-17 cells), and anti-inflammatory regulatory cells (such as FOXP3-positive regulatory T cells). Moreover, specific soluble biomarkers (S100 proteins) can guide individual treatment. Altogether these new developments in genetics, immunology, and imaging are instrumental to better define, classify, and treat patients with juvenile idiopathic arthritis.
幼年特发性关节炎是一组异质性疾病，其特征为病因不明的关节炎，发病年龄在 16 岁之前。过去 5 年中的关键性研究在多个领域取得了实质性进展，范围涵盖疾病分类到新的治疗方法。基因表达谱研究已在疾病的不同亚型中确定了不同的免疫机制，并有助于重新定义疾病分类标准。此外，免疫学研究表明，全身型幼年特发性关节炎是一种获得性自身炎症性疾病，并已成功开展白介素-1 和白介素-6 阻断治疗的研究。在其他形式的疾病中，滑膜炎症是促炎效应细胞（如辅助性 T 细胞 17 细胞）与抗炎调节细胞（如 FOXP3 阳性调节性 T 细胞）之间失衡的结果。此外，特定的可溶性生物标志物（S100 蛋白）可指导个体化治疗。总之，遗传学、免疫学和影像学方面的这些新进展有助于更好地定义、分类和治疗幼年特发性关节炎患者。
