Prieur A M
Service de Pédiatrie, Hôpital Necker-Enfants Malades, Paris.
Rev Rhum Mal Osteoartic. 1990 Apr 10;57(3 ( Pt 2)):280-6.
In France, about 3,000 children under 16 years of age suffer from juvenile chronic arthritis (JCA), whose management presents a problem. JCA covers several nosological entities. In 20% of the cases, a systemic form affecting the articulations in an inconstant way, and starting in the very young child, is observed. In 30% of the cases, a form with a polyarticular start is observed. This group is very heterogeneous and includes in particular early seropositive rheumatoid arthritis (RA), the little girls' polyarthritis with presence of antinuclear antibodies, and the little boys' rheumatisms HLA B27. Finally, in 50% of the cases, an oligoarticular form is observed, also expressed in greatly varying ways. In all cases, the evolution is unpredictable and the management of these children is different from that of adults. It must be noted that the treatments used in adults are rarely applied to children as JCA is a pathology which is quite different from RA. Several types of treatment can be administered by general route: non-steroidal antiinflammatory drugs (NSAIDs) and mainly aspirin, since few NSAIDs have a paediatric licence in France. However, the risks of intolerance at doses reaching up to 100 mg/kg are not negligible. Some NSAIDs can be used in older children. The slow acting drugs are dangerous in the systemic form of JCA. Their indication seem to be more appropriate in the polyarticular forms. In the oligoarticular forms, slow acting drugs are rarely proposed. Corticosteroids are prescribed in aspirin-resistant systemic forms only. Besides the complications observed in adults, the growth is stopped in a constant way.(ABSTRACT TRUNCATED AT 250 WORDS)
在法国，约3000名16岁以下儿童患有青少年慢性关节炎（JCA），其治疗是个难题。JCA涵盖多种疾病实体。20%的病例为全身型，以不固定方式累及关节，起病于幼儿。30%的病例为多关节起病型。该组非常异质性，尤其包括早期血清阳性类风湿关节炎（RA）、存在抗核抗体的女童多关节炎以及HLA B27阳性的男童风湿病。最后，50%的病例为少关节型，其表现也差异很大。在所有病例中，病情发展不可预测，这些儿童的治疗与成人不同。必须指出，成人使用的治疗方法很少应用于儿童，因为JCA是一种与RA截然不同的疾病。几种治疗可通过常规途径给药：非甾体抗炎药（NSAIDs），主要是阿司匹林，因为在法国很少有NSAIDs有儿科许可。然而，剂量高达100mg/kg时不耐受的风险不可忽视。一些NSAIDs可用于年龄较大的儿童。慢作用药物在JCA全身型中危险。它们似乎在多关节型中应用更合适。在少关节型中，很少建议使用慢作用药物。仅在阿司匹林抵抗的全身型中使用皮质类固醇。除了成人中观察到的并发症外，生长会持续停止。（摘要截短于250字）
