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Juvenile rheumatoid arthritis is a clinical syndrome of primary chronic arthritis in childhood. JRA is subdivided into three subtypes according to the clinical picture within six months of the onset of the disease. The clinical picture of systemic onset type usually starts with a characteristic spiking fever. Children with this onset type, sometimes have pleursy, percarditis, myocarditis, generalyzed lymphnode swelling, hepatosplenomegaly and rheumatoid rash, but arthritis may not appear within the first few months. Children with polyarticular onset type, joint manifestations are similar to that of the rheumatoid arthritis of the adult. In patients with the pauciarticular onset type, the prognosis of arthritis is relatively fair compared with the other two types, but the doctor must always be aware of the complication of chronic and recurrent uveitis which sometimes develop to glaucoma, without subjective signs.  相似文献   

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The authors studied the response to and side effects of long-term glucocorticoid (GC) therapy of systemic juvenile rheumatoid arthritis (SJRA). GC were given to 24 girls and 9 boys at the age of 4 to 15 years with classic SJRA in a mean dose 1.6 +/- 0.13 mg/kg (24.0 +/- 0.55 mg/day) for 6.3 +/- 0.55 years, on the average. Mean duration of the disease was 7.1 +/- 0.55 years. 94% of the patients had lymphaticohypolastic constitution. Long-term GC monotherapy in a dose 0.2-0.5 mg/kg/day failed to control a SJRA course and to produce an immunosuppressive effect while side effects were severe: inhibition of activity of the hypothalamohypophysioadrenal system and resultant hormone dependence (100%), Cushing's syndrome (97%), nanism (85%), osteoporosis (64%), secondary infections (58%), aseptic necrosis of heads of the femur (52%). Oral GC treatment is not effective as first-line therapy of SJRA. It should be used as adjuvant to immunodepressants. Intraarticular and/or intravenous administration is preferable.  相似文献   

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AIM: To develop an effective and safe therapeutic policy for Sandimmun-Neoral in order to prevent joint destruction, invalidation, achieve higher life quality in patients with systemic juvenile rheumatoid arthritis (SJRA). MATERIALS AND METHODS: The trial included 26 patients with SJRA aged 4-15 years. 12 of them had early SJRA, 14--late SJRA. 13 patients received Neoral for one year and the other 13 for 2-3.5 years. Markers of aggressive SJRA course in the debut were registered in all the patients. Previous treatment incorporated nonsteroid antiinflammatory drugs, intraarticular corticosteroids (all the patients), prednisolone (19 patients), methotrexate (3 patients). Before Neoral treatment 80% of the patients had structural alterations in the joints, signs of invalidation, low quality of life. SJRA activity was defined as the 3d degree. All the patients suffered from obesity, hypertrichosis, steroid spondylopathy, nanism. RESULTS: Neoral recovered joint motility in 30% of patients, 60% were capable for self-service. Quality of life was assess as high in 80%, moderately reduced--in 20%. 35% of the patients achieved clinico-laboratory remission. The disease activity dropped to degree I-II in 65% of patients. Structural changes in the joints stopped progressing in 77%, regress of the anatomic stage was seen in 20% of patients. Prednisolone was discontinued in 7 and dose-reduced in 6 patients. Exogenic hypercorticism relieved and growth resumed in all the patients. Neoral proved effective both in early and late SJRA, inhibited destruction both in patients in remission and in active disease. Side effects were: hypertrichosis in 13 patients, moderate blood hypertension in 1 case. CONCLUSION: Neoral can control the disease. It is indicated both in early and late SJRA in the presence of aggressive course markers, acute coxitis with aseptic necrosis of the head of the femur or free of it. Neoral treatment should be started as early as on the first year of the disease, before the structural changes in the joints. For safe long-term therapy it is valid to give cyclosporin A in monotherapy or in combination with voltaren in minimal doses. Corticosteroids are used on demand. The preference should be given to intraarticular or intravenous prolonged drugs but not oral prednisolone which may course such severe complications as obesity, hypertension, nanism.  相似文献   

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The authors present the current data on the disorders of immune functions in patients suffering from rheumatoid arthritis (RA). Provide evidence for the pathogenetic heterogeneity of the known clinical patterns of RA, mainly seronegative and seropositive varieties, with special reference to the differences in the lowering of the activity of nonspecific T suppressors, to the influence of the factor of necrosis of alpha-tumor and alpha- and beta-interferons on B lymphocyte proliferation, and to the effects of synovial exudate from seropositive and seronegative patients. Demonstrate the results of integral estimation of the disorders of several characteristics of the immune system in RA patients with the use of the image recognition program. It is concluded that the clinical polymorphism of RA is specified by the pathogenetic heterogeneity of the disease based on varieties of combined normal and altered functions of different components of the immune system.  相似文献   

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Synovectomy, total arthroplasty and arthrodesis are the main surgical methods for rheumatoid arthritis. Although recurrent synovitis and radiological deterioration after synovectomy have been reported, the procedure can be an effective treatment if it is performed in the early stage where articular cartilage and bone are minimally damaged. Arthrodesis is indicated for severely destroyed joints. However, since loss of motion in the proximal joints often leads to severe disability, its indication is limited to the distal joints, such as the wrist and ankle. Total rthroplasty seems to be an ideal method because relief of pain and recovery of function can be obtained simultaneously. However, there are some complications, such as loosening and wear of the prosthesis. Solution of these would bring much benefit to the disabled rheumatoid arthritis patient.  相似文献   

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OBJECTIVE: To review the classification, pathophysiology, safety, and efficacy of treatment options for juvenile rheumatoid arthritis (JRA). Etanercept, the agent most recently approved by the Food and Drug Administration for use in JRA, is featured. DATA SOURCES: Articles were identified from a search of the MEDLINE database (1966 to January 2000) and through secondary sources. Meeting abstracts and posters were also evaluated. STUDY SELECTION AND DATA EXTRACTION: Articles identified and retrieved from data sources were evaluated and, if determined to be relevant, were included in this review. DATA SYNTHESIS: JRA represents a major cause of functional disability in children. In contrast to traditional therapeutic agents for JRA, which act through generalized antiinflammatory activity or generalized immunosuppression, new therapeutic modalities have been developed that target specific molecules involved in the pathophysiology of JRA. Etanercept inhibits the activity of tumor necrosis factor and lymphotoxin-alpha. In a clinical trial of patients with polyarticular-course JRA, etanercept-treated patients experienced less pain and swelling in their joints, decreased incidence of disease activity, less frequent flare, and a longer time to flare than patients receiving placebo. Treatment with etanercept was generally well-tolerated. CONCLUSIONS: Etanercept represents an exciting new therapeutic option for the treatment of JRA. The positioning of etanercept among other therapeutic options for JRA will be more clearly established as additional safety and efficacy data are made available.  相似文献   

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目的:通过对幼年类风湿性关节炎患儿的护理,达到缓解病情,减轻痛苦,促进康复,提高患儿的生活质量。方法:在药物治疗的基础上给予心理护理、对症护理及出院指导方法。结果:患儿配合临床治疗和护理,防止和减少了临床并发症的发生,取得了满意的效果。结论:系统的统合护理措施可提高幼年类风湿病患者的临床疗效,有效地促进患儿康复。  相似文献   

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The efficacy of recombinant gene engineering alpha 2-interferon (reaferon) was studied and compared in 60 patients suffering from verified juvenile rheumatoid arthritis (JRA). Reaferon was shown to possess good tolerance and to produce an adequate therapeutic effect. The combined use of reaferon and methotrexate permits potentiating the therapeutic effect of interferon and avoiding side effects seen with methotrexate used alone. Besides, it makes it possible to reduce the incidence of respiratory infections which are often associated with exacerbation of the underlying disease when treated by conventional methods.  相似文献   

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One hundred consecutive children with juvenile rheumatoid arthritis (JRA) were evaluated for shoulder dysfunction. Shoulder arthritis was virtually absent in all 45 children with pauciarticular onset JRA. Twenty of 40 children (50%) with polyarticular JRA and 12 of 15 (80%) with systemic onset JRA had shoulder involvement characterized by pain or restricted passive range of motion (PROM). Ninety-five percent of those with shoulder arthritis had bilateral involvement. Children with systemic onset were likely to have shoulder disease within 2.5 years of onset and to have more severely limited PROM. Children with polyarticular onset developed shoulder arthritis any time during the course of their disease. With either type of onset, internal rotation was the most commonly and severely limited motion, followed by abduction. Clinicians treating children with JRA should carefully monitor pain and examine both rotational and planar components of shoulder motion.  相似文献   

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