Clinical Characteristics And Follow-up Of Juvenile Idiopathic Arthritis

Objective: To analyze the clinical characteristics and follow-up of different subtypes of juvenile idiopathic arthritis(JIA)in order to deepen the understanding of JIA.Methods: The clinical data of 100 JIA patients admitted to Pediatric Internal Medicine from the Third Hospital of Hebei Medical University from August 2013 to November 2019 were collected,and their clinical manifestations,auxiliary examination,diagnosis and treatment methods,and follow-up changes were analyzed.Results: 1.There were 53 males and 47 females in 100 patients,the ratio of males to females was about 1.12:1.According to the age of onset,all patients were divided into three groups: 0-6 years old,7-12 years old and over 12 years old.The average age of onset was 6.58 ± 3.87 years old.Oligoarthritis was the most common subtype of JIA,accounting for 69%.Except for the polyarticular patients,there are more male patients than female patients in other subtypes.There was no statistically difference in gender among patients with different subtypes of JIA(P>0.05),there were statistically differences in the age of onset among patients with different subtypes of JIA(P <0.05);2.Ninety eight percent of patients show joint symptoms as the main manifestation,and may also have fever,rash,organ involvement,and lymphadenopathy,which can be complicated by uveitis and macrophage activation syndrome.At present,there is no specific auxiliary examination to diagnose the disease.There may be inflammatory indicators such as ESR,C-reactive protein(CRP),and platelet elevation during the active disease period,which may be accompanied by hemoglobin reduction,abnormal immune indicators,rheumatoid factor(RF)positive,human leucocyte antigen-B27(HLA-B27)positive,anti-Cyclic citrullinated peptide(CCP)antibodies and Antinuclear antibodies are positive,and some patients require bone marrow examination.X-ray,CT,MRI,and ultrasound examinations of the joints are helpful in the differential diagnosis and monitoring of the disease;3.Forty six patients were followed up,most of them were oligoarthritis(30 cases).Only four patients were treated with non steroidal anti-inflammatory drugs(NSAIDs)alone to control the disease.Most of the patients needed to use the combination of disease alleviation anti rheumatic drugs(DMARDs),if the effect was poor,biological agents were added.Some patients need short-term treatment with Glucocorticoid(GC).There were 6 patients with side effects of DMARDs,which were liver transaminase increase or gastrointestinal reaction;4.During the follow-up,most of the patients were well controlled by drugs.Four patients were lost to follow-up after the clinical symptoms were alleviated.Joint deformity occurred in 3 patients,growth retardation in 1 patient,recurrent disease in 11 patients,uveitis in 3 patients,and unilateral blindness in 1 patient.Conclusions:1.Oligoarthritis is the most common in this research,and the age of onset is mostly below 7 years old.It is followed by polyarticular JIA,and most patients are RF negative.2.The most common clinical manifestations of JIA patients are joint pain,which can be accompanied by fever,morning stiffness,rash,hepatosplenomegaly and lymphadenopathy.Complications may include uveitis and Macrophage Activation Syndrome.The index of systemic inflammatory activity may be abnormal in the active phase of disease.3.Antinuclear antibodies were positive in patients with uveitis in this research.Uveitis is usually asymptomatic at first and can occur at any time during the course of JIA,which suggests that JIA patients should not give up their eye examination at any time.4.Most young patients are sensitive to pain,which is helpful to our early detection of the disease.Some patients' symptoms are not obvious at the time of onset,and it is difficult to find them in young patients,especially those under 6 years of age.The nature and location of pain is difficult to describe accurately in language,and imaging studies are particularly important in diagnosis.5.Early diagnosis is beneficial to reduce the occurrence of joint deformities and blindness in patients.In the follow-up of JIA patients,the growth and development should be paid attention to,and infections should be prevented and JIA related knowledge should be popularized with parents to improve patients medical compliance.