ICUkNAL CLU8 DISCUSSICN

kLSLN1LD CN 23 IUNL 2011

MCDLkA1LD 8 kCI k AGAkWAL
kLSLN1LD 8 Dk U1kAkSn SnAnI (Ik II)
DLAk1MLN1 CI Ck1nCALDICS
LkA'S LUCkNCW MLDICAL CCLLLGL nCSI1AL
CLINICAL kLVILW
DIAGNCSIS MANAGLMLN1 CI
IUVLNILL IDICA1nIC Ak1nkI1IS
W Au1PC8S
Iemke n M r|nce
Mar|eke n Ctten
L|sette W A van Su|[|ekomSm|t
W 9ACL Cl S1uu?
ueparLmenL of 9aedlaLrlcs/9aedlaLrlc 8heumaLology Lrasmus MC
Sophla Chlldren PosplLal 8oLLerdam neLherlands
ulvlslon of 8heumaLology lmmunology Allergy 8rlgham
Women's PosplLal Parvard Medlcal School 8osLon uSA
W 9u8lSPLu ln
8MI ICUkNAL CI Ck1nCALDICS (IanIeb 2011)
ClLaLlon Code 8M! 2010314c6434
AccepLed on 4 CcLober 2010 ( dol 101136/bm[c6434)
ln18CuuC1lCn
W !uvenlle ldlopaLhlc ArLhrlLls ls Lhe mosL common cause
of chronlc arLhrlLls ln chlldhood
W A revlew of 34 dlfferenL epldemlologlcal sLudles
showed LhaL 007401 per 1000 chlldren worldwlde
are effecLed
W lL ls characLerlzed by [olnL lnflammaLlon LhaL ofLen
leads Lo [olnL desLrucLlon wlLh physlcal dlsablllLy
chronlc paln LhaL effecLs dally llfe
1
W uurlng Lhe pasL decade lncreased undersLandlng of Lhe
dlsease has lnproved Lhe LreaLmenL parLlcularly
Lhrough earller dlagnosls and new LreaLmenLs LhaL help
Lo prevenL long Lerm damage Lo [olnL
1
Cst||e IL Aas|and A Iohansson I I|ato 8 Mo||er A A |ong|tud|ona| fo||ow up study of phys|ca|
psycho|og|ca| hea|th |n young adu|ts w|th chron|c ch||dhood arthr|t|s C||n Lxp kheumato| 200927103946
ln18CuuC1lCn
W ln year 2010 1he 8rlLlsh SocleLy for 9aedlaLrlc
AdolescenL 8heumaLology publlshed sLandards
of care for chlldren and young people wlLh
!uvenlle ldlopaLhlc arLhrlLls whlch ouLllned Lhe
lmporLance of lnvolvlng dlfferenL dlsclpllnes
wlLhln healLhcare
2
W 1hls cllnlcal revlew ls abouL recenL advances ln
Lhe dlagnosls and managemenL of !uvenlle
ldlopaLhlc ArLhrlLls focuslng on evldences from
randomlsed conLrol Lrlals cohorL sLudles
sysLemaLlc revlews and currenL guldellnes
2
Dav|es k C|eary G Ioster n nutch|nson L 8a||dam L 8SAk standards of care for ch||dren and young
peop|e w|th Iuven||e |d|opath|c arthr|t|s kheumato|(Cxford) 20104914068
uLllnl1lCn
W Iuven||e Id|opath|c Arthr|t|s
(formerly !uvenlle Chronlc ArLhrlLls
ln Lurope and !uvenlle 8heumaLold
ArLhrlLls ln norLh Amerlca) covers
heLerogeneous group of condlLlons
more accuraLely descrlbed as
subLypes
W 1he dlsease encompasses all forms
of arLhrlLls LhaL beglns before Lhe
age of 16 years perslsLs for more
Lhan 6 weeks are of unknown
causes
3
3
etty kL Southwood 1k Manners 8aum I G|ass DN Go|denberg I et a| Internat|ona| |eague of assoc|at|ons for
rheumato|ogy c|ass|f|cat|on of kheumato|d Arthr|t|s second rev|s|on Ldmonton 2001 Irheumato| 2004313902
!uvLnlL lulC9A1PlC A81P8l1lS Su81?9LS
(lA8 9roposed ClasslflcaLlon CrlLerla)
System|c Iuven||e Id|opath|c Arthr|t|s
C||goarthr|t|s
- ers|stent
- Lxtended
o|yarthr|t|s
- kheumato|d factor pos|t|ve
- kheumato|d factor negat|ve
sor|at|c Arthr|t|s
Lnthes|t|s ke|ated Arthr|t|s
Und|fferent|ated Arthr|t|s
11
33
16
3
17
6
3
3
ercentage of Cccurance
SysLemlc !lA
9erslsLenL CllgoarLhrlLls
LxLended CllgoarLhrlLls
8heumaLold lacLor 9oslLlve
9olyarLhrlLls
8heumaLold lacLor negaLlve
9olyarLhrlLls
9sorlaLlc ArLhrlLls
LnLheslLls 8elaLed ArLhrlLls
undlfferenLlaLed ArLhrlLls
98LulS9CSlnC lAC1C8S
W lL ls LhoughL Lo be mulLlfacLorlal auLolmmune dlsease
wlLh envlronmenLal geneLlc conLrlbuLory facLors
4
W 1he heLerogenelLy of Lhe subLypes change ln
Lermlnology classlflcaLlon make lL dlfflculL Lo
lnLerpreL sLudles on role of envlronmenL

W 1he mosL common rlsk facLors are lnfecLlons ln

comblnaLlon wlLh geneLlc suscepLlblllLy
W Many oLher facLors such as sLress maLernal smoklng
are LhoughL Lo conLrlbuLe Lo Lhe paLhogenesls
4 rakken 8I A|ban| S Us|ng b|o|ogy of d|sease to understand gu|de therapy of IIA 8est ract kes C||n
kheumato| 2009239960
8erkun adeh S Lnv|ronmenta| factors the geoep|dem|o|ogy of [uven||e |d|opath|c arthr|t|s
Auto|mmune kev 20109A31924
0
1
2
3
4
3
6
7
SysLemlc !lA
9erslsLenL CllgoarLhrlLls
LxLended CllgoarLhrlLls
8heumaLold lacLor 9oslLlve 9olyarLhrlLls
8heumaLold lacLor negaLlve 9olyarLhrlLls
9sorlaLlc ArLhrlLls
LnLheslLls 8elaLed ArLhrlLls
23
33
6
08
39
64
17
ke|at|ve r|sk (Luropean V NonLuropean)
Iuven||e Id|opath|c Arthr|t|s
Immune
mechan|sms
normona|
Iactor
Genet|c
Iactor