Clinical Characteristics And Efficacy Evaluation Of Oligoarticular Juvenile Idiopathic Arthritis

Objective: The disease characteristics and diagnosis and treatment process of 93 children with oligoarticular JIA were summarized and analyzed,which provided a reference plan for clinical work.Methods:A retrospective analysis was made on 93 children with oligoarticular JIA diagnosed from January 1,2010 to December 31,2022 in the Pediatric Kidney Rheumatology Immunology Unit of Shengjing Hospital Affiliated to China Medical University,recorded their gender,age of onset,pre-admission course,laboratory indicators and imaging results,explored the relationship between joint involvement,age of onset and course before admission,and compared the differences in laboratory indicators between children with oligoarticular JIA and normal children.The treatment drugs were celecoxib,methotrexate and tumor necrosis factor receptor-antibody fusion protein,and the effects of different drug regimens on joint symptoms and prognosis were compared,and when the conventional treatment effect was not good,biological agents were added to the children,and the JADAS score was used to evaluate disease activity。Result: Among the 93 children with oligoarticular JIA,most of them were females,and most of them presented to the doctor within 3 months after the onset of illness.The most common area affected was the knee joint,and the involvement is associated with the age of onset,most often in children under 6 years of age or younger.Compared with healthy children,children with oligoarticular JIA showed a decreasing trend in hemoglobin(118.72±10.47g/L),while C-reactive protein(12.48±22.17mg/L)and erythrocyte sedimentation rate(33.09±26.03mm/h)showed an increasing trend,and the difference was statistically significant(P<0.05).Imaging examinations were divided into four categories: joint X-ray,joint MRI,joint CT and joint ultrasound,and the results were mainly those with effusion and soft tissue swelling.In terms of the treatment effect of half a year,it was found that the number of people in group 1(tumor necrosis factor receptor-antibody fusion protein + methotrexate + celecoxib)in treatment was significantly higher than that in group 2(celecoxib + methotrexate)and group 3(celecoxib),which was statistically significant(P<0.05).Subsequently,according to whether tumor necrosis factor receptor-antibody fusion protein was used,it was found that the time of joint symptom relief in group A(combined with biologics treatment group)was significantly earlier than that in group B(non-biological treatment group)(P<0.05),and there was no statistical difference in CRP values between the two groups after 4 weeks of medication,but both were within the normal range,while there was a difference in ESR values between the two groups,but the difference was not statistically significant.In addition,8 patients in group B who scored highly active were added to tumor necrosis factor receptor-antibody fusion protein in subsequent treatment due to poor efficacy,and after regular follow-up and scoring,it was found that 3 cases became inactive after 16 weeks of combination therapy,and 75% became inactive after 28 weeks.Conclusions: Among children with oligoarticular JIA,the knee joint is the most common part of involvement,and its involvement is affected by the age of onset,and the number of people aged less than or equal to 6 years is significantly higher than that of More than 6 years old.Compared with normal healthy children,children with oligoarticular JIA are more likely to have mild anemia,high inflammatory state(elevated C-reactive protein and erythrocyte sedimentation rate),and some children are positive for ANA and ANCA.The imaging findings included X-ray,ultrasound,MRI,CT,mainly with effusion combined with soft tissue swelling.In terms of treatment,tumor necrosis factor receptor-antibody fusion protein + methotrexate(MTX)+ celecoxib regimen is the most effective in alleviating joint symptoms and has the shortest onset time。For patients who do not respond well to the original regimen,some children can still reduce their condition to the inactive stage after combined tumor necrosis factor receptor-antibody fusion protein therapy.