幼年型类风湿性关节炎临床观察

本文报告１９７１年～１９９２年住院治疗的４４例幼年型类负湿性关节炎，描述了其临床表现和主要实验室检查及Ｘ线所见，４４例入院时确诊本病２４例，余者均误诊，治疗上本组病例分３组进行观察，以阿斯匹林和消炎痛疗效最好。     

幼年型类风湿性关节炎临床及免疫学特点

目的：探讨感染及免疫功能紊乱与幼年型类风湿性关节炎（JRA）发病的关系。方法：回顾分析30例JRA患儿临床及实验室资料。结果：30例JRA中全身型占63．3％（19例）；病原检出率达56．7％（17／30例），病毒为第1位，依次为EB病毒（EBU）、柯萨奇病毒（CVB）、乙肝病毒（HBV），细菌以溶血性链球菌及肠道球、杆菌为主，同时检出2种及3种病原各1例；活动期C反应蛋白（CRP）明显升高（P＜0．01），免疫球蛋白IgG、IgA显著高于对照组（P＜0．01），CD8^ 增高（P＜0．05），CD3^ 、CD4^ ／CD8^ 比值显著降低（P均＜0．01），CD4^ 无显著变化（P＞0．05），自然杀伤细胞（NK），淋巴因子激活杀伤细胞活性明显降低（P均＜0．001）。结论：持续感染反复抗原刺激可能破坏了机体的免疫自稳，启动病理性免疫应答，与JRA的发生发展有关。JRA患儿机体自身免疫监控能力下降。     

幼年型类风湿性关节炎心脏损害临床分析

目的 探讨幼年型类风湿性关节炎(JRA)心脏损害的发生率及临床特点。方法 回顾分析85例JRA患儿临床特征及实验室资料。结果 JRA患儿心脏损害发病率为28．1％(24／85)，其中心肌病变17例(20．2％)，心包炎6例(7．1％)，心律失常5例(5．88％)。结论 JRA所致心脏损害并非少见，超声心动图对JRA心脏损害有重要的诊断价值。     

全身型幼年型类风湿性关节炎18例随访分析

为了解全身型幼年型类风湿性关节炎 (JRA)的预后 ,探讨影响预后的相关因素 ,回顾性分析了临床资料 ,并进行了1年～11年的随访。结果显示 ,缓解8例 (占44.44 % ) ,死亡2例 ,残疾4例 ,反复发作4例 ,致死致残率为33.33 % (6/18例 ) ,未缓解率为56.56 % ;缓解组与未缓解组在发病年龄上差异无显著性 (P>0.05) ,而在关节外症状严重程度 (如 :发热和皮疹持续时间、淋巴结和肝脾肿大程度 )、末梢血白细胞计数、血沉以及早期采用的治疗方案上 ,两组间差异均有显著性 (P<0.05)。提示JRA(全身型 )的预后较差 ,发热和皮疹持续时间越长 ,淋巴结和肝脾肿大的程度越重 ,预后越差 ;早期采用小剂量强的松、非甾体抗炎药和甲氨喋呤/中药治疗方案 ,可改善预后     

幼年型类风湿性关节炎64例预后及相关因素分析

目的 探讨幼年型类风湿性关节炎(JRA)的预后及影响预后的相关因素。方法 回顾性分析64例JRA患儿的临床资料,并进行7个月～15年随访。结果 1.30例缓解(缓解率46.9％),12例反复发作,2例复发,17例残疾,3例死亡(致残致死率31.3％)。2.正规治疗组和非正规治疗组缓解率分别为87.0％和24.4％(x~2=23.2 P<0.005),残疾和死亡共20例均在非正规治疗组(x~2=12.9 P<0.05)。3.发病后6个月内和6个月后正规治疗组缓解率分别为94.4％和60.0％(x~2=4.09 P<0.05)。4.JRA预后与发病年龄、性别无关(P>0.05),与临床分型有关,少关节型预后差(x~2=13.25 P<0.05)。结论 JRA缓解率低,致残致死率较高,尤以少关节型预后差。早期采用正规治疗对于改善JRA的远期预后至关重要。     

幼年型类风湿性关节炎40例临床诊治体会

1982～1997年我科共收治结缔组织病患儿260例,其中确诊为幼年型类风湿关节炎40例,占15.4％。现将诊治情况报告如下。 资料与结果 一、临床资料 男18例,女22例,男女比例为1:1.2。年龄6～13岁,平均年龄9岁。农村29例,城市11例。受累关节数≥4个者10例(25.0％),受累关节数≤4个者10例(25.0％),高热、间歇热、类     

中西医结合治疗幼年型类风湿性关节炎临床观察

1997年 5月～ 2 0 0 1年 1月对幼年型类风湿性关节炎应用非甾体类药物、激素及免疫抑制剂配合中药汤剂治疗 ,疗效较好 ,现报告如下。资料和方法一、一般资料　治疗组 3 4例 ,男 2 5例 ,女 9例 ,年龄 4～15岁 ,平均 10 .2 8岁。全身型 6例 ,少关节型 16例 ,多关节型 12例 ,病程 8个月～ 3年 ,平均 1.76± 1.13年。对照组 3 5例 ,男 2 6例 ,女 9例 ,年龄 3～ 15岁 ,平均 10 .16岁。全身型6例 ,少关节型 13例 ,多关节型 6例 ,病程 7个月～ 4年 ,平均 1.82± 1.0 6年。按何晓琥等整理幼年类风湿性关节炎诊断及分型入选[1] 。外院治疗病情缓解 ,…     

幼年型类风湿性关节炎24例临床分析

幼年类风湿性关节炎 (ＪＲＡ)是儿童时期一种常见的风湿类疾病 ,临床分为系统型、多关节炎型和少关节炎型。由于本病病因不甚明了 ,起病方式、临床表现多样 ,治疗和疾病转归亦不尽相同 ,而引起人们日益广泛关注。现将我院１９９９年５月至２００１年７月门诊及病房诊治的２４例ＪＲＡ患儿的临床特点、诊断和治疗情况报道如下。资料与方法一、病例选择２４例均为本院门诊及住院患儿 ,所有患儿都详细询问临床表现、治疗情况及家族史 ,全面查体 ,并进行血常规、尿常规、血沉 (ＥＳＲ)、Ｃ -反应蛋白 (ＣＲＰ)、血清类风湿因子 (ＲＦ)、抗核抗体…     

多种药物治疗难治性幼年型类风湿性关节炎4例报告

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120例幼年型类风湿性关节炎的特征及相关检验的临床意义

幼年型类风湿性关节炎(JRA)是儿童常见结缔组织病之一,具有临床表现多样化、早期诊断困难、病程迁延、反复发作,晚期致骨关节畸形等特点。我院1982年～1998年16年间共收治120例,现将临床及检验特征与诊治体会报道如下。     

幼年类风湿性关节炎96例的预后和转归

目的　探讨幼年类风湿性关节炎 (JRA)的远期预后和转归。方法　对 1988～ 1992年我院诊断为JRA患儿通过门诊、信函进行随访 ,随访 84～ 13 2个月 ,并对随访者病情、治疗经过、目前情况及生活状况进行分析。结果　完成随访 96例 ,1例死于霍奇金病 ;余 95例中全身型 44例 ,2例于发病第 7年死于感染 ,2 3例发展为严重关节炎 ,17例完全缓解 (CR) ,2例部分缓解 (PR) ;少关节炎型 3 8例 ,2 7例在发病 10年后仍有活动性关节炎 ,9例诊断为强直性脊柱炎 ;多关节炎型 13例 ,3例类风湿因子 (RF)阳性均出现关节畸形。结论　JRA预后不良 ,尤其全身型 ,影响预后主要因素有年龄、发热、炎症表现、系统受累及治疗情况。少关节炎Ⅱ型约 3 0 %以上发展为强直性脊柱炎。多关节炎型RF阳性者关节畸形发生率高 ,预后不佳     

幼年特发性关节炎患儿血清瘦素的检测及意义

关于幼年特发性关节炎(JIA)与瘦素(leptin)关系的研究国外报道较少,国内尚未见报道。我们对27例JIA患儿血清瘦素进行了检测,现将结果报道如下。1对象和方法1.1对象2003年9月～2005年3月我院住院及门诊JIA患儿27例,其中男14例,女13例;平均年龄(7.2±2.4)岁。所有患儿均符合2001年加拿大埃得蒙顿会议制定的诊断标准眼1演,其中全身型19例,少关节型4例,多关节型3例,与附着点炎症相关关节炎1例。所有患儿均未经激素及免疫抑制剂治疗。对照组选择健康儿童25例,男12例,女13例;年龄(7.3±1.9)岁;均无心、脑、肾及其他内分泌系统疾病,且无性征发…     

Transient scoliosis in a child with juvenile rheumatoid arthritis

An 8 year old girl was admitted to hospital complaining of arthralgia in a few large joints. According to the clinical course and serological tests, a diagnosis of a polyarticular type of juvenile rheumatoid arthritis was made. About 6 weeks after the onset, scoliosis was observed. The curvature regressed spontaneously over the following 6 months. Generally, scoliosis associated with juvenile rheumatoid arthritis has been noted a few years after the onset. A transient scoliosis in the early phase of this disease is rare.     

Mizoribine in the treatment of rheumatoid arthritis and juvenile idiopathic arthritis

BACKGROUND: Mizoribine (MZR), isolated from culture medium of the mold, is a novel immunosuppressant developed in Japan. It has been used in patients with renal transplantation, lupus nephritis, nephrotic syndrome and rheumatoid arthritis (RA). OBJECTIVES: To review MZR in regards to mechanism of action, pharmacokinetics, efficacy and safety in the treatment of rheumatoid RA and juvenile idiopathic arthritis (JIA). RESULTS: The drug MZR inhibits both humoral and cellular immunity in RA patients. It is completely excreted in the urine within 24 h, which contributes to the safety of MZR. A series of multicenter studies indicated that MZR was effective and safe in the treatment of RA. In JIA, however, there are only a few case reports reporting its efficacy and safety. CONCLUSION: A double-blinded multicenter study is needed to establish the efficacy, safety and indication of MZR in the treatment of JIA.     

A study of prognosis in 52 cases with juvenile rheumatoid arthritis

The prognosis in 52 patients with juvenile rheumatoid arthritis (JRA) was studied. There were 35 cases of systemic onset, 12 of polyarticular onset and 5 of pauciarticular onset. Thirteen systemic cases developed a polycyclic course with chronic polyarthritis. Many monocyclic JRA in systemic cases subsided within 1 year. There were no instances of polyarticular cases or pauciarticular cases that shifted to other type. However, there were many cases with a long active polyarticular JRA and with remission at an early stage in the pauciarticular type. The stage and class were I or II in 90% of cases with a good prognosis for the joints, but there were some serious cases. Transient carditis or iritis which developed at an early stage subsided later. The intractable systemic cases had drug-induced complications. The cases with steroid-induced complications tended to be chronic. One death in a systemic case was caused by hepatic failure.     

Antiperinuclear factor in the diagnosis of juvenile rheumatoid arthritis

The antiperinuclear factor (APF) was estimated by immunofluorescent microscopy in the sera of 32 children and adolescents with juvenile rheumatoid arthritis (JRA) in comparison to a group of 16 children and adolescents with other rheumatologic disorders and a group of 20 age-matched healthy subjects. The APF was detected in 17 children with JRA (53%), in only one patient in the group of other rheumatologic disorders (6%), and in 2 healthy children (10%). Accordingly, APF had a sensitivity of 53%, a specificity of 92%, and a diagnostic efficiency of 74% in our series. APF was found to have a higher diagnostic gain in rheumatoid factor (RF) seronegative cases than did the RF in APF negative cases, meaning a higher sensitivity of APF as compared to the RF. The APF seropositivity was neither altered by the use of corticosteroids nor influenced by the age, gender, duration of illness, or number of joints affected. Three out of 5 patients with JRA had the APF detected in their synovial fluid; they were running rather a severe course of illness. The use of the APF could be an aid in the diagnosis of JRA.     

膝关节超声检查在幼年类风湿性关节炎诊断中的价值

目的 探讨膝关节超声检查在幼年类风湿性关节炎(JRA)诊断及疗效评价中的价值。方法 超声检查JRA30例活动期患儿48个膝关节；10例缓解期患儿16个膝关节；30例正常儿60个膝关节。观察指标包括膝关节髌上囊滑膜厚度、积液量、关节股骨端软骨轮廓形态。结果 JRA活动期膝关节明显积液、滑膜明显增厚，与缓解期、正常对照组间均有显著差异；JRA患儿中10个膝关节出现软骨轮廓改变。结论 超声能客观定量评价JRA患儿膝关节的病变，为临床JRA的诊断及疗效观察提供客观、敏感、定量的检查方法。     

Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis

OBJECTIVE: To evaluate the prevalence of recent parvovirus B19 infection in a cohort of children presenting with acute arthropathy and to determine the prevalence of a subsequent diagnosis of juvenile rheumatoid arthritis in this cohort. METHOD: In this prospective study, parvovirus B19 IgM antibody was investigated in 75 patients who were referred to our clinic with acute joint complaints and also in 75 healthy controls. One patient in each group was excluded due to neuroblastoma and acute lymphoblastic leukaemia. The characteristics of parvovirus B19 IgM positive patients who were accepted as parvovirus B19 arthropathy were further evaluated. All the patients were followed up for at least 6 weeks and the patients with chronic progression of joint complaints were followed for at least 6 months to determine their progress. The cases of juvenile rheumatoid arthritis in this chronic group were identified. RESULTS: Parvovirus B19 IgM was detected in 16 of 74 patients (21.6%) with acute arthropathy compared with 3 of 74 (4.1%) in the healthy control group (chi(2) = 8.67; P = 0.003). The parvovirus B19 positive patients with arthropathy were more likely to become chronic (P = 3.7 x 10(-7)) and to be diagnosed as juvenile rheumatoid arthritis (P = 0.03) than the parvovirus B19 IgM negative group with arthropathy. Additional joint destruction developed in one case who was parvovirus B19 IgM positive in whom juvenile rheumatoid arthritis was diagnosed during follow up. CONCLUSION: These data support the hypothesis that parvovirus B19 infection may be associated with the onset of juvenile rheumatoid arthritis in a proportion of patients.