Michels H
Kinder- und Rheumakinderklinik, Garmisch-Partenkirchen.
Z Arztl Fortbild Qualitatssich. 1997 Jun;91(3):219-26.
Juvenile chronic arthritis (JCA) and other pediatric chronic rheumatic diseases such as the more rare juvenile collagenoses and the systemic vasculitides represent illnesses with a substantial potential of long-term problems and are additionally associated with a significant degree of mortality. Seen among the long-term problems associated with JCA are functional loss, deformities and the destruction of afflicted joints, a visual loss which may extend as far as blindness as a consequence of rheumatic iridocyclitis, irreversible organ damage caused by AA-amyloidosis as well as growth failure. Apart from cutaneous manifestations, on the other hand, the collagenoses and systemic vasculitides also demonstrate an involvement of specific organ systems, particularly of the kidneys, the lungs, the brain or the gastrointestinal tract. There is no causal therapy available. However, the application of a multidimensional therapeutic regimen primarily involving antirheumatic drugs, physiotherapeutic and ergotherapeutic methods as well as the application of a psychosocial treatment and the aid of governmental support, has resulted in good long-term results for most children suffering from JCA. The collagenoses and systemic vasculitides, however, have proven to be more problematic although the full utilization of the possibilities which are available today has provided encouraging results for most of these afflicted children. The complex therapeutic scheme, however, requires interdisciplinary cooperation. The pediatrician and/or family physician must fulfill crucial responsibilities which are relevant for the continuing prognosis of the illness. The pediatrician/general practitioner must thereby maintain a situation of close cooperation with the patient and their family as well as with the various colleagues active in the therapeutic team, especially with the pediatric rheumatologists. Moreover, these physicians also play a central role in establishing an early diagnosis in monitoring the disease progress and the therapy as well as in providing the mandatory assistance in the event of acute problems.
青少年慢性关节炎（JCA）以及其他儿科慢性风湿性疾病，如较为罕见的青少年胶原病和系统性血管炎，都是具有长期问题潜在风险的疾病，并且还与相当程度的死亡率相关。在与JCA相关的长期问题中，有功能丧失、畸形以及受累关节的破坏，由于风湿性虹膜睫状体炎可能导致视力丧失甚至失明，AA淀粉样变性引起的不可逆器官损伤以及生长发育迟缓。另一方面，除了皮肤表现外，胶原病和系统性血管炎还表现出特定器官系统受累，特别是肾脏、肺、脑或胃肠道。目前尚无因果疗法。然而，应用主要涉及抗风湿药物、物理治疗和职业治疗方法以及心理社会治疗和政府支持的多维治疗方案，已使大多数患有JCA的儿童取得了良好的长期效果。然而，尽管充分利用目前可用的治疗方法已为大多数这些患病儿童带来了令人鼓舞的结果，但胶原病和系统性血管炎已被证明更具问题。然而，复杂的治疗方案需要跨学科合作。儿科医生和/或家庭医生必须履行与疾病持续预后相关的关键职责。儿科医生/全科医生必须与患者及其家人以及治疗团队中的各种同事保持密切合作，特别是与儿科风湿病学家。此外，这些医生在早期诊断、监测疾病进展和治疗以及在出现急性问题时提供必要援助方面也发挥着核心作用。
