JUVENILE RHEUMATOID ARTHRITIS

A Look into the Etiology? Treatment and Current Research of Juvenile Rheumatoid Arthritis

Abstract

This paper focuses on the Juvenile Rheumatoid Arthritis (JRA). And several subgroups of JRA are well identified and they disagree in clinical manifestations? prognosis? exact autoimmune features? and genetic determinants. The most common extra-articular manifestation of JRA is an insidious symptomatic anterior uveitis with a chronic infection course. Chronic scarring-type uveitis is a frequent extra-articular manifestation of Juvenile Rheumatoid Arthritis. It occurs in about 20% of children with this disease? commencing typically within a few years from its onset. The risk of uveitis is greatest in antinuclear antibody-positive girls with early onset oligoarthritis. The classic clinical picture is chronic bilateral anterior uveitis? usually asymptomatic until substantial damage to intraocular structures occurs. In view of the asymptomatic nature of the condition? routine screening of Juvenile Rheumatoid Arthritis patients 2-4 times a year is crucial to prevent complications. The treatment consists of topical corticosteroids and mydriatics? in severe cases with immunosuppressive agents? and surgical management of complications. Although the prognosis of uveitis is improving? there are cases refractory to standard regimens.

Table of Contents

I. Introduction4

II. Pecific Aims5

III. Nomenclature and classification5

IV. Clinical characteristics of the infection subtypes8

A. Systemic arthritis8

B. Oligoarthritis (Also entitled pauciarthritis)8

C. Rheumatoid factor-negative polyarthritis9

D. Rheumatoid factor-positive polyarthritis9

E. Psoriatic arthritis9

F. Enthesitis-related arthritis10

G. Other forms10

IV. Occurrence of Juvenile Rheumatoid Arthritis10

V. Occurrence of uveitis in Juvenile Rheumatoid Arthritis12

VI. Genetics of Juvenile Rheumatoid Arthritis15

VII. Pathogenesis of Juvenile Rheumatoid Arthritis-associated chronic uveitis18

VIII. Clinical image of uveitis in Juvenile Rheumatoid Arthritis20

IX. Relation of look of uveitis to that of arthritis23

X. Activity of arthritis in relative to occurrence of uveitis24

XI. Complications of uveitis in Juvenile Rheumatoid Arthritis25

XII. Treatment of uveitis in Juvenile Rheumatoid Arthritis28

A. Local treatment29

B. Systemic treatment30

C. Treatment of difficulties of uveitis affiliated with Juvenile Rheumatoid Arthritis32

XIII. Improving prognosis of uveitis in Juvenile Rheumatoid Arthritis60

XIV. Guidelines for screening for uveitis and follow-up of patients with Juvenile Rheumatoid Arthritis66

XV. Method of publications search67

References71

A Look into the Etiology? Treatment and Current Research of Juvenile Rheumatoid Arthritis

I. Introduction

Juvenile Rheumatoid Arthritis (JRA) is characterised as an arthritis of unidentified origin of not less than 6 weeks length beginning before the patient's 16th birthday. Several subgroups of JRA are well identified and they disagree in clinical manifestations? prognosis? exact autoimmune features? and genetic determinants. The most common extra-articular manifestation of JRA is an insidious symptomatic anterior uveitis with a chronic infection course. Although its prognosis is improving? as an outcome of early acknowledgement and punctual remedy with topical corticosteroids and mydriatics (and in critical cases? with immunosuppressive agents) ? and to improvement in surgical remedy of complications? some young children nonetheless become visually handicapped. A large dispute to ophthalmologists and paediatric haematologists is how to save the view of these children.

Ophthalmologists rarely glimpse patients with JRA-associated uveitis? not only when they are young children but more often when they have come to mature individual age. Few ophthalmologists? however? have profited ample know-how in exact difficulties affiliated with this illness. Severe hold ups may take location before the patients arrive into ...