Akioka Shinji
Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Nihon Rinsho Meneki Gakkai Kaishi. 2016;39(6):513-521. doi: 10.2177/jsci.39.513.
Juvenile idiopathic arthritis, JIA, is a novel rheumatic disease in childhood introduced by the International League of Associations for Rheumatology. It is defined as a chronic, inflammatory disorder of unknown etiology, which is classified into seven categories; systemic-onset type, persistent and extended oligoarthritis, polyarthritis with rheumatoid factor negative, polyarthritis with rheumatoid factor positive, psoriatic arthritis, enthesitis-related arthritis and undifferentiated arthritis. As each category of JIA has different features in clinical phenotypes, precise subtyping is required for research and management. However, some modifications to the criteria might be helpful for getting better answers in diagnosis because of ethnical difference in prevalence and subtype distribution. Actually in Japanese population, a unique subset "B27-negative polyenthesitis" termed by Shichikawa should be included in enthesitis-related arthritis of JIA as a different type of enthesitis from B27-positive counterpart of spondyloarthritis in adulthood. Deep insights into the classification criteria will be needed for the better understanding of JIA.
幼年特发性关节炎(JIA)是由国际风湿病联盟提出的一种儿童期新型风湿性疾病。它被定义为一种病因不明的慢性炎症性疾病,分为七类:全身型、持续性和扩展性少关节炎、类风湿因子阴性多关节炎、类风湿因子阳性多关节炎、银屑病关节炎、附着点炎相关关节炎和未分化关节炎。由于JIA的每一类在临床表型上都有不同特点,因此研究和管理需要精确的亚型分类。然而,由于患病率和亚型分布存在种族差异,对标准进行一些修改可能有助于在诊断中获得更好的答案。实际上,在日本人群中,石川提出的独特亚组“B27阴性多附着点炎”应作为与成人脊柱关节炎B27阳性对应物不同类型的附着点炎纳入JIA的附着点炎相关关节炎。为了更好地理解JIA,需要深入了解分类标准。