Upper endoscopic findings in children with active juvenile chronic arthritis.
OBJECTIVE
To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA).


METHODS
This was a prospective, open, non-randomized study. Gastroscopy was performed on 45 children with active JCA in 1996-2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate.


RESULTS
Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n = 24) than in children without symptoms (n = 21) (75% vs 38%, p = 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p = 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p = 0.02).


CONCLUSIONS
Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.
Ashorn
M
M
Department of Paediatrics, University of Tampere, Medical School, Tampere, Finland. merja.ashorn@uta.fi
Verronen
P
P
Ruuska
T
T
Huhtala
H
H
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects / Q000293:injuries* / Q000473:pathology*; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal