Rheumatoid Arthritis: Guillaume S

Guillaume S. · INSERM U345, Faculté de Médecine Necker-Enfants, Malades, Paris. · Presse Med. · Pubmed #10745947 No free full text.

Abstract: DIAGNOSIS: Juvenile idiopathic arthritis involving 1 to 4 joints is the most frequent inflammatory chronic rheumatic disorder observed in children. Diagnosis, based on clinical features and laboratory findings may be difficult. Septic arthritis and malignant hematopathy as well as other neoplastic conditions must be ruled out first. Chronic asymptomatic uveitis must be searched for without delay. NATURAL COURSE: The natural course is variable. Prognosis is generally good if the disease remains limited to one joint. Conversely, the development of ocular complications and extension to other joints may lead to less favorable outcome. EARLY MULTIDISCIPLINARY CARE: Rheumatologists, pediatricians, ophthalmologists, pediatric orthopedic surgeons, and physical therapy and psychotherapy specialists all have a role to play. The treatment of choice in case of resistance to nonsteroidal antiinflammatory drugs is local infiltration using long-action fluorinated corticosteroids. Methotrexate is indicated in case of extension to other joints and symmetrical involvement. It is crucial to institute a physical therapy program early because of the risk of induced deformations which may become irreversible. Chronic uveitis, which must be looked for systematically, responds well to local corticosteroids given in a long-term protocol. Early multidisciplinary care is essential for optimal long-term outcome.

Guillaume S, Koné-Paut I. · Service de rhumatologie pédiatrique et pédiatrie Générale, CHU Bicêtre, AP-HP, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. <> · Arch Pediatr. · Pubmed #18582784 No free full text.

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Guillaume S, Prieur AM, Coste J, Job-Deslandre C. · Université Paris V, France. · Arthritis Rheum. · Pubmed #10943877 links to  free full text

Abstract: OBJECTIVE: To describe the long-term outcome and determine predictors of severity among patients with oligoarticular-onset juvenile idiopathic arthritis (JIA). METHODS: In a longitudinal study, 207 patients with oligoarticular-onset JIA who were referred between 1988 and 1998 were evaluated. At disease onset, selected clinical and laboratory data were collected as independent variables. A polyarticular disease course, joint erosion, uveitis, and remission were assessed as dependent variables. Longitudinal analyses were performed with the Kaplan-Meier method, and multivariate analysis with the Cox model. RESULTS: After 6 years of followup, the probability of a polyarticular course of disease was 50%, joint erosion was 35%, uveitis was 30%, and remission was 23% in these patients. Joint erosion was strongly associated with a polyarticular course. A high erythrocyte sedimentation rate (ESR) as well as involvement of more than 1 joint or involvement of an upper limb at disease onset were predictors of disease extension. A high ESR was also a strong predictor of a destructive course, and a family history of psoriasis was predictive of uveitis occurrence. No predictive factor for remission could be identified. CONCLUSION: Oligoarticular-onset JIA is a severe disease with frequent complications. Factors predictive of severity in oligoarticular-onset JIA were identified. This could allow early identification of high-risk patient subgroups, warranting a more aggressive therapeutic approach.