title: Management of the upper extremity in juvenile rheumatoid arthritis.
abstract: Juvenile rheumatoid arthritis is a multifaceted disease. Average age of onset is 6 years, with peaks between 1 and 4 and between 9 and 14 years. Girls are affected more frequently than boys. Nonsteroidal anti-inflammatory drugs are the standard first line of therapy. Second-line therapy of antirheumatic drugs may be used early for progressive disease. Intra-articular corticosteroid injections should be considered to preserve joint mobility and muscle strength when medical treatment fails to control synovitis or when marked functional impairment exists. Historically, surgery has been a last resort, but in appropriate patients, it should be considered soon after failure of conservative management. However, when possible, reconstructive surgery should be delayed until completion of skeletal growth.
authors.affiliation: Department of Orthopaedic Surgery, University of Kentucky, Lexington, USA.
authors.forename: Dane
authors.initials: D
authors.lastname: Glueck
authors.forename: Harris
authors.initials: H
authors.lastname: Gellman
mesh_terms: D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D004551:Elbow Joint; D005384:Finger Joint; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D000069285:Infliximab; D008662:Metacarpophalangeal Joint; D008727:Methotrexate / Q000627:therapeutic use; D010396:Penicillamine / Q000627:therapeutic use; D012785:Shoulder Joint; D013933:Thumb; D014955:Wrist Joint
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D006886:Hydroxychloroquine; D000069285:Infliximab; D010396:Penicillamine; D008727:Methotrexate