[Juvenile oligoarthritis. A diagnosis not to be ignored].
METHODS
Juvenile idiopathic arthritis involving 1 to 4 joints is the most frequent inflammatory chronic rheumatic disorder observed in children. Diagnosis, based on clinical features and laboratory findings may be difficult. Septic arthritis and malignant hematopathy as well as other neoplastic conditions must be ruled out first. Chronic asymptomatic uveitis must be searched for without delay.
The natural course is variable. Prognosis is generally good if the disease remains limited to one joint. Conversely, the development of ocular complications and extension to other joints may lead to less favorable outcome.
Rheumatologists, pediatricians, ophthalmologists, pediatric orthopedic surgeons, and physical therapy and psychotherapy specialists all have a role to play. The treatment of choice in case of resistance to nonsteroidal antiinflammatory drugs is local infiltration using long-action fluorinated corticosteroids. Methotrexate is indicated in case of extension to other joints and symmetrical involvement. It is crucial to institute a physical therapy program early because of the risk of induced deformations which may become irreversible. Chronic uveitis, which must be looked for systematically, responds well to local corticosteroids given in a long-term protocol. Early multidisciplinary care is essential for optimal long-term outcome.
Guillaume
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INSERM U345, Faculté de Médecine Necker-Enfants, Malades, Paris.
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D026741:Physical Therapy Modalities; D011379:Prognosis; D011613:Psychotherapy; D013997:Time Factors; D014605:Uveitis / Q000175:diagnosis / Q000628:therapy
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal