JIA تعالی بالینی

Views:
 
Category: Entertainment
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

slide 1:

Journal of Clinical Excellence A review of clinical and laboratory findings and treatment of Juvenile Idiopathic Arthritis JIA Reza Shiari 1 Vadood Javadi Parvaneh 2 1. Associate Professor of Pediatric Rheumatology Mofid Childrens Hospital Shahid Beheshti University of Medical Sciences Tehran Iran 2. Fellow of Pediatric Rheumatology Mofid Childrens Hospital Shahid Beheshti University of Medical Sciences Tehran Iran .Corresponding Author: Shariati Ave Hosseinieh Ershad Department of Pediatric Rheumatology of Mofid Childrens Hospital Shahid Beheshti University of Medical Sciences Tehran Iran. E-mail: shiarezayahoo.com Received 31 Januuary 2014 Accepted 11 August 2014 Abstract Juvenile idiopathic arthritis JIA refers to a group of disorders characterized by chronic arthritis. It is a chronic rheumatic disease and one of the major causes of disability in children. The diagnosis of JIA disease in children younger than 16 years with arthritis swelling or effusion or two about decreased range of motion warmth pain or tenderness for at least 6 weeks and rule out of other causes of arthritis with which they would be identifiable. The incidence and prevalence of JIA from 1 to 20 per 100000 to 400 per 100000 have been reported. There are several separated classification criteria for patients under 16 years of age who have chronic arthritis. The most practical and acceptable criteria are presented by American College of RheumatologyACR European League against RheumatismEULAR and the International League of Associations for RheumatologyILAR. Furthermore spondyloarthritis in young children including psoriatic arthritis and ankylosing spondylitis are being diagnosed with difficulty. Here in we discussed about chronic arthritis in children and the differences between these classification criteria. Keywords: Juvenile Idiopathic Arthritis Diagnosis Chronic Arthritis J Clin Exc 2014 22:19-35Persian. Review 19

slide 2:

2 1393 - 2 35 - 19 JIA 1 2 Juvenile Idiopathic Arthritis: JIA . JIA . 16 6 . 16 . American College of Rheumatology: ACR European League against Rheumatism: EULAR International League of Associations for Rheumatology: ILAR . . . : Juvenile Idiopathic Arthritis: JIA . JIA . 1 . 2 . : : E-mail: shiarezayahoo.com : 1 1 / 11 / 92 : 21 / 11 / 92 : 20 / 5 / 93 20

slide 3:

2 1393 16 6 . JIA 1 20 100000 10 400 100000 2 1 . 16 : American College of Rheumatology: ACR European League Against Rheumatism: EULAR International League of Associations for Rheumatology:ILAR . 1 : ILAR 1997 JIA EULAR 1978 JCA ACR1977 JRA RF RF JRA ACR: American College of Rheumatology EULAR: European League Against Rheumatism IBD: Inflammatory Bowel Disease ILAR: International League of Associations for Rheumatology JCA: Juvenile Chronic Arthritis JIA: Juvenile Idiopathic Arthritis JIA: Juvenile Rheumatic Arthritis RF: Rheumatic Factor. 1 . . 1 2 . ILAR . T T . JIA 1 2 6 2 IL-1B IL-6 IL2R Th1 . IL-6 IL-2R TNF Tumor Necrosis Factor CRP C- Reactive Protein 3 . 6 SOJIA Systemic Onset JIA 4 . 2 : ILAR EULAR ACR 7 6 3 16 16 16 6 3 6 JAS JPsA IBD ACR: American College of Rheumatology EULAR: European League Against Rheumatism IBD: Inflammatory Bowel Disease ILAR: International League of Associations for Rheumatology JAS: Juvenile Ankylosing Spondylitis JPsA: Juvenile Psoriatic Arthritis 21

slide 4:

2 1393 JIA ILAR 7 : Systemic onset juvenile Idiopathic Arthritis SoJIA RF Rheumatic Factor RF Enthesitis Realated Arthritis: ERA Juvenile Psoriatic Arthritis: JPsA . JIA . Pitting . JIA JIA 5 6 . . . . ANA Anti Nuclear Antibody . 4 JIA . 6 5 JIA . 50 30 2 6 - 4 . : 2 4 ESR Erythrocyte Sedimentation Rate ANA . 6 5 . JIA 5 JIA . RF negative RF positive 6 . 7 . RF . RF . . . HLA Human Leukocyte Antigen Adult Rheumatoid Arthritis 12 - 8 . . 16 - 13 . JIA Systemic onset Juvenile Idiopathic Arthritis: 22

slide 5:

2 1393 SoJIA JIA HLA . : . 10 . . SoJIA 2 2 . . . 2-10mm . . . . SoJIA 6 . . . SoJIA . 6 18 17 . : Macrophage Inhibitory Factor: MIF fibrin D-Dimer 18 . SOJIA . SOJIA 19 - 17 . Macrophage Activation Syndrome: MAS . NonSteroidal Anti Inflamatory Drugs: NSAIDs 20 - 18 . MAS ill . PT PTT . ESR MAS SOJIA 20 . 23

slide 6:

2 1393 Infalamatoary Bowel Disease: IBD Entesitis Related Arthritis: ERA 2 . 8 21 . HLAB27 23 22 . . ERA RF ANA . 24 . : 20 JIA 10 ANA . JIA JIA 25 . JIA . 30 . 26 . 1mg/kg/day A 28 27 . JIA . SOJIA . 29 . JIA . . SoJIA 30 . . / JIA . Bone Mineral Density: BMD 5 / 2 . 24

slide 7:

2 1393 . BMD JIA D 31 . 32 31 . mg 1500 - 1200 400 D . 33 . / Huygen JIA . JIA 34 . Schanberg 5 JIA . Schanberg 10 35 . JIA . JIA 36 . JIA . 37 JIA . 5 / 2 95 4 / 5 1 / 1 5 / 5 95 8 / 9 - 6 / 1 II-IV . . 12 30 SoJIA 3 4 38 . 72 SoJIA JIA 39 38 . RF . SoJIA 39 . JIA . JIA . 25

slide 8:

2 1393 . SoJIA Systemic Lupus Erythematosis: SLE 40 . JIA . SoJIA . JIA . 41 . . . . SoJIA 42 . JIA . SLE 43 40 . ANA SLE JIA . SoJIA SLE ds- DNA Anti SLE . . 45 44 . JIA . 6 . . . . . T-cell B-cell . . Reactive Arthritis: ReA 46 . HLA-B27 ReA 46 . 26

slide 9:

2 1393 47 . B19 B HIV . 48 . . SoJIA 49 . . . . 50 . ESR . . . . . 51 . JIA . JIA Deasease Midifying Anti Rheumatic Drugs: DMARDs . . . 52 . NSAIDs . NSAIDs 6 8 . 15 20 mg/kg 500 mg 20 30 mg/kg 3 600 mg 40 mg/kg 3 800 mg . NSAIDs . 55 - 53 . 1 - 2 mg/kg/day 200 mg/day 27

slide 10:

2 1393 ERA SoJIA . 56 . cox-2 Celecoxib cox-2 cox-1 . 57 - 53 . . SoJIA . 30 mg/kg 1 SOJIA 58 . . . 10 40 mg . : 59 54 . 3 3 . . DMARDs JIA : . DMARDs Auranofin placebo- controlled double-blind . Placebo-controlled Double-blind . JIA HLA-B27 . 59 - 56 . . CBC Complete Blood cell Count 3 3 3 . 28

slide 11:

2 1393 JIA 78 . 85 JIA . SOJIA . JPsA . . 0.3mg/kg/week 0.6 mg/kg/dose . 60 - 58 . 13 . . JIA . . 59 58 . CBC . . 3 . . JIA . 60 . JIA . . TNF Tumor Necrosis Factor . PPD . PPD 1 . IVIG 64 - 61 . SoJIA IL-1 IL-6 . Remission 65 . 29

slide 12:

2 1393 : JIA . JIA . . JIA . JIA . JIA . References 1. Oen KG Cheang M. Epidemiology of chronic arthritis in childhood. Semin Arthritis Rheum. 1996 26:575-91. 2. Andersson Gare B. Juvenile arthritis-who gets it where and when A review of current data on incidence and prevalence. Clin Exp Rheumatol. 199917:367-74. 3. McInnes IB Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nat Rev Immunol. 20077:429-42. 4. Ou LS See LC Wu CJ Kao CC Lin YL Huang JL. Association between serum inflammatory cytokines and disease activity in juvenile idiopathic arthritis. Clin Rheumatol. 200221:52-6. 5. Cassidy JT Levinson JE Bass JC Baum J Brewer EJ Jr Fink CW et al. A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum. 1986 Feb292:274-81. 6. Kahn P Juvenile Idiopathic ArthritisAn Update for the Clinician. Bulletin of the NYU Hospital for Joint Diseases. 2012703:152-66. 7. Oen K Petty RE Schroeder ML. Anassociat ion between HLA-A2 and juvenile rheumatoid arthritis in girls. J Rheumatol. 1982 9:916-20. 8. Farivar S Shiari R Elham Hadi. Genetic Susceptibility to Juvenile Idiopathic Arthritis in Iranian Children. Arch of Med Research 2011 42:301-4. 9. Murray KJ Moroldo MB Donnelly P Prahalad S Passo MH Giannini EH et al. Age-specific effects of juvenile rheumatoid arthritis-associated HLA alleles. Arthritis Rheum. 1999 42:1843-53. 10. Zeggini E Donn RP Ollier WER Thomson W. The Arthritis Rheum. 2002 46:2716-20. 11. Moroldo MB Donnelly P Saunders J Glass DN Giannini EH. Transmission disequili- brium as a test of linkage and association between HLA alleles and pauciarticular- onset juvenile rheumatoid arthritis. Arthritis Rheum. 1998 41:1620-4. 12. Hall PJ Burman SJ Laurent MR Briggs DC Venning HE Leak AM et al. Genetic susceptibility to early onset pauciarticular juvenile chronic arthritis: a study of HLA and complement markers in 158 British patients. Ann Rheum Dis. 1986 45:464-74. 13. Paul C Yao Z Nevinny-Stickel C Keller E Schoenwald U Truckenbrodt H et al: Immunogenetics of juvenile chronic Arthritis I: HLA interaction between A2 DR5/8-DR/DQ and DRB10201 is a general feature of all subsets of early onset pauciarticular juvenile chronic arthritis. II: DPB18 polymorphism plays a role in systemic juvenile chronic arthritis. Tissue Antigens. 1995 45:280-3. 14. Martini A. Are the number of joints involved or the presence of psoriasis still useful tools to identify homogeneous disease entities in juvenile idiopathic arthritis. J Rheumatol. 2003 30:1900-3. 30

slide 13:

2 1393 15. Ravelli A Felici E MagniManzoni S Pistor io A Novarini C Bozzola E et al. Patients with antinuclear antibody- positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum. 2005 52:826-32. 16. Cannizzaro E Schroeder S Muller LM Kellenberger CJ Saurenmann RK. Temporomandibular joint involvement in children with juvenile idiopathic arthritis. J Rheumatol. 2011383:510-5. 17. Behrens EM Beukelman T Gallo L Spangler J Rosenkranz M Arka- chaisri T et al. Evaluation of the presentation of systemic onset juvenile rheumatoid arthritis: Data from the Pennsylvania systemic onset juvenile arthritis registry Pasojar. J Rheumatol. 200835:343 8. 18. Woo P. Systemic juvenile idiopathic arthritis: Diagnosis management and outcome. Nat Clin Pract Rheumatol. 2006 2:28 34. 19. Grom AA Passo M. Macrophage activation syndrome in systemic juvenile rheumatoid arthritis. J Pediatr.1996 129:630 2. 20. Davi S Consolaro A Guseinova D Pistorio A Ruperto N Martini A et al. An international consensus survey of diagnostic criteria for macrophage activation syndrome in systemic juvenile idiopathic arthritis. J Rheumatol. 201138:764 8. 21. Cabral DA Oen KG Petty RE. SEA syndrome revisited: a longterm followup of children with a syndrome of seronegative enthesopathy and arthropathy. J Rheumatol. 1992 19:1282-5. 22. Flato B Aasland A Vinje O Forre O: Outcome and predictive factors in juvenile rheumatoid arthritis and juvenile spondyloarthropathy. J Rheumatol 1998 25:366-75. 23. Minden K Kiessling U Listing J Niewerth M Doring E Meincke J et al. Prognosis of patients with juvenile chronic arthritis and juvenile spondyloarthropathy. J Rheumatol. 2000 27:2256-63. 24. Burgos-Vargas R. Juvenile onset spondylo arthropathies: therapeutic aspects. Ann Rheum Dis. 2002 61Suppl 3:iii33-9. 25. Heinz C Mingels A Goebel C Fuchsluger T Heiligenhaus A. Chronic uveitis in children with and without juvenile idiopathic arthritis: differences in patient characteristics and clinical course. J Rheumatol. 2008 35:1403 7. 26. Jabs DA Rosenbaum JT Foster CS Holland GN Jaffe GJ Louie JS et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000130:492 513 27. Waheed NK Miserocchi E Foster CS. Ocular concerns in juvenile rheumatoid arthritis. Int Ophthalmol Clin. 200141:223- 34. 28. Miserocchi E Baltatzis S Ekong A Roque M Foster CS. Efficacy and safety of chlorambucil in intractable noninfectious uveitis: the Massachusetts Eye and Ear Infirmary experience. Ophthalmology. 2002109:137 42. 29. Cleary AG Lancaster GA Annan F Sills JA Davidson JE. Nutritional impairment in juvenile idiopathic arthritis Rheumatology oxford 200443:1569-73. 30. Umawska W Prusek-Dudkiewicz A. Growth retardation and delayed puberty in children and adolescents with juvenile idiopathic arthritis. Arch Med Sci. 2010 61: 19 23. 31. Cassidy JT Langman CB Allen SHHillman LS. Bone mineral metabolism in children with juvenile rheumatoid arthritis. Ped Clin North Am. 1995 42:1017-33. 32. Pepmueller PH Cassidy JT Allen SH Hillman LS. Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthri Rheumatol.1996 395:746-57. 33. Roth J Bechtold S Borte G Dressler F Hermann J Borte M. Osteoporosis in juvenile idiopathic arthritis- a practical. Eur J Pediatr. 2007 1668:775-84. 34. Huygen ACJ Kuis W Sinnema G. Psychological behavioural and social adjustment in children and adolescents with juvenile chronic arthritis. Ann Rheum Dis. 2000 594:276-82. 35. Schanberg LE Gil KM Anthony KK Yow E Rochon J. Pain stiffness and fatigue in juvenile polyarticular arthritis: contempo- raneous stressful events and mood as predictors. Arthri Rheum. 2005524:1196- 204. 36. Anthony KK Schanberg LE. Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin North Am. 2005522:611-39. 37. Steinbrocker O Traeger CH Batterman RC. Therapeutic criteria in rheumatoid arthritis. JAMA. 1949140:659-62. 38. Gurcay E Eksioglu E Yuzer S Bal A Cakci A. Articular damage in adults with juvenile idiopathic arthritis. Rheumatol Int. 2009296:635-40. 31

slide 14:

2 1393 39. Packham JC Hall MA. Long term follow up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology. 20024112: 1428-35. 40. Klein-Gittelman M Reiff A Silverman ED. Systemic lupus erythematosus in childhood. Rheum Dis Clin North Am. 2002283:561 77. 41. McMinn FJ Bywaters EG. Differences between the fever of Stills disease and that of rheumatic fever. Ann Rheum Dis. 195918:293 7. 42. de Boer JH Sijssens KM Smeekens AE Rothova A. Keratitis and arthritis in children with sarcoidosis. Br J Ophthalmol. 2009 936:835-44. 43. Farivar S Shiari R Nejad Hosseinian M Eshtad S. New Genetic finding in systemic Lupus Erythruatosus. Genetics in the 3rd Millennium. 2008 6 2:1333-8. 44. Shiari R Kiumarsi A Adibe Eshgh F Allameh MA. Juvenile Dermatomyositis in Iranian children: A case series report. Annal of Ped Rheumatol. 2012 11:5-11. 45. Shiari R Elahi S Gharib A. Jadali F. Amyopathic juvenile dermatomyositis: A case presentation. Joint Bone Spine.2009 76:722-3. 46. Panush RS Paraschiv D Dorff RE. The tainted legacy of Hans Reiter. Semin Arthritis. Rheum. 2003324:231 6. 47. Uziel U Perl L Barash J Hashkes PJ. Post- streptococcal reactive arthritis in children: a distinct entity from acute rheumatic fever. Pediatr Rheumatol Online J. 2011 9: 32. 48. Märker-Hermann E Schütz N Bauer H. Viral arthritides. Z Rheumatol. 2010 6910:871-8. 49. Shiari R. Kawasaki Disease A Review Article. Arch Ped Inf Dis. 2013 14: 154-9. 50. Cabral DA Tucker LB. Malignancies in children who initially present with rheumatic complaints. J Pediatr. 19991341:53 7. 51. Cassas KJ Cassettari-Wayhs A.Childhood and Adolescent Sports-Related Overuse Injuries. Am Fam Physician. 2006 736: 1014-22. 52. Long AR Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol. 2010222:213-7. 53. Brostrom E Hagelberg S Haglund-Akerlind Y. Effect of joint injections in children with JIA: evaluation by 3D-gait analysis. Acta Pediatr. 2004937:906 10. 54. Zulian F Martini G Gobber D Plebani M Zacchello F Manners P. Triamcinolone acetonide and hexacetonide intraarticular treatment of symmetrical joints in juvenile idiopathic arthritis: a double blind trial. Rheumatology. 200443:1288 91. 55. Milojevic DS Ilowite NT. Treatment of rheumatic diseases in children: special considerations. Rheum Dis Clin North Am. 2002 28:461 82. 56. van Rossum MA Fiselier TJ Franssen MJ Zwinderman AH ten Cate R van Suijlekom-Smit LW et al. Sulfasalazine in the treatment of juvenile chronic arthritis: a randomized double-blind placebo- controlled multicenter study. Dutch Juvenile Chronic Arthritis Study Group. Arthritis Rheum.199841:808 16. 57. Burgos-Vargas R Vázquez-Mellado J Pacheco-Tena C Hernández-Garduño A Goycochea-Robles MV. A 26 week randomised double blind placebo controlled exploratory study of sulfasalazine in juvenile onset spondyloarthropathies. Ann Rheum Dis. 20026110:941 2. 58. Ruperto N Murray KJ Gerloni V Wulffraat N de Oliveira SK Falcini F Dolezalova P et al. A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum. 2004 50:2191 201. 59. Alsufyani K Ortiz-Alvarez O Cabral DA Tucker LB Petty RE Malleson PN. The role of subcutaneous administration of methotrexate in children with juvenile idiopathic arthritis who have failed oral methotrexate.J Rheumatol. 2004311:179 82. 60. Silverman E Mouy R Spiegel L Jung LK Saurenmann RK Lahdenne P et al. Leflunomide or methotrexate for juvenile rheumatoid arthritis. N Engl J Med. 2005 Apr 2135216:1655-66. 61. Southwood TR Foster HE Davidson JE Hyrich KL Cotter CB Wedderburn LR et al. Duration of etanercept treatment and reasons for discontinuation in a cohort of juvenile idiopathic arthritis patients. Rheumatology Oxford. 201150:189 19. 62. Lovell DJ Ruperto N Goodman S Reiff A Jung L Jarosova K et al. The pediatric rheumatology collaborative study group the pediatric rheumatology international trials organisation. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N Engl J Med. 2008 359: 810 20. 63. Quartier P Allantaz F Cimaz R Pillet P Messiaen C Bardin C et al. A multicentre randomised double-blind placebo- controlled trial with the IL-1 receptor antagonist anakinra in patients with 32

slide 15:

2 1393 systemic-onset juvenile idiopathic arthritis ANAJIS trial. Ann Rheum Dis. 2011 705:747-54 64. Woo P Wilkinson N Prieur AM Southwood T Leone V Livermore P et al. Open label Phase 2 trial of single ascending doses of MRA in Caucasian children with severe systemic juvenile idiopathic arthritis: proof of principle of the efficacy of IL-6 receptor blockade in this type of arthritis and demonstration of prolonged clinical improvement. Arthritis Res Ther. 200576:R1281-8 65. De Kleer IM Brinkman DM Ferster A Abinun M Quartier P Van Der Net J et al. Autologous stem cell transplantation for refractory juvenile idiopathic arthritis: analysis of clinical effects mortality and transplant related morbidity. Ann Rheum Dis. 200463:1318 26. 33

slide 16:

2 1393 1 - JIA 2 - JIA 3 - JIA HLA 4 - JIA 5 - SoJIA 6 - 7 - 3 SoJIA . PT PTT 34

slide 17:

2 1393 ESR . SoJIA DIC MAS 8 - JIA 9 - TMJ 10 - JIA 35

authorStream Live Help