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#16
21.07.2009, 14:28
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Я приведу главу из современного учебника по педиатрической ревматологии Textbook of Pediatric Rheumatology, 5th ed., 2005
CHAPTER 9 – CHRONIC ARTHRITIS IN CHILDHOOD James T. Cassidy, Ross E. Petty Chronic arthritis in childhood—characterized as juvenile rheumatoid arthritis (JRA) (Table 9-1), juvenile chronic arthritis (JCA) (Table 9-2), or juvenile idiopathic arthritis (JIA) (Table 9-3)—is one of the most common rheumatic diseases of childhood. It is also one of the more frequent chronic illnesses of children and an important cause of short- and long-term disability. Although it has been customary to refer to this disorder as a single disease, it almost certainly comprises a number of similar entities, characterized principally by arthritis of the appendicular joints, each of which has distinct modes of presentation and may have the same or different causes. It may also be considered as a closely related series of host-determined specific responses with an immunoinflammatory pathogenesis, possibly activated by contact with an external antigen or antigens. A dauntingly complex immunogenetic predisposition is often present. The relative frequencies of the three principal onset types (oligoarthritis, polyarthritis, and systemic onset) have varied considerably in published series and reflect the biases that confound estimates of incidence and prevalence (Table 9-4).[1,][2] There are also potential ethnic differences in onset types.[3] Clinical aspects of these onset types are discussed in detail in Chapters 10, 11, and 12 Chapter 10 Chapter 11 Chapter 12. TABLE 9-1 -- Criteria for the Classification of Juvenile Rheumatoid Arthritis 1. Age at onset <16 yr 2. Arthritis (swelling or effusion, or presence of two or more of the following signs: limitation of range of motion, tenderness or pain on motion, and increased heat) in one or more joints 3. Duration of disease 6 wk or longer 4. Onset type defined by type of disease in first 6 mo: a. Polyarthritis: ≥5 inflamed joints b. Oligoarthritis (pauciarticular disease): <5 inflamed joints c. Systemic-onset: arthritis with characteristic fever 5. Exclusion of other forms of juvenile arthritis Modified from Cassidy JT, Levinson JE, Bass JC, et al.: A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum 29: 274–281, 1986. TABLE 9-2 -- Criteria for a Diagnosis of Juvenile Chronic Arthritis 1. Age at onset <16 yr 2. Arthritis in one or more joints 3. Duration of disease 3 mo or longer 4. Type defined by characteristics at onset: a. Pauciarticular: <5 joints b. Polyarticular: >4 joints, rheumatoid factor negative c. Systemic: arthritis with characteristic fever d. Juvenile rheumatoid arthritis: >4 joints, rheumatoid factor positive e. Juvenile ankylosing spondylitis f. Juvenile psoriatic arthritis From European League Against Rheumatism (EULAR) Bulletin 4. Nomenclature and Classification of Arthritis in Children. Basel, National Zeitung AG, 1977. TABLE 9-3 -- Proposed Classification Criteria for Juvenile Idiopathic Arthritis: Durban, 1997 1. Systemic 2. Oligoarthritis a. Persistent b. Extended 3. Polyarthritis (rheumatoid factor negative) 4. Polyarthritis (rheumatoid factor positive) 5. Psoriatic arthritis 6. Enthesitis-related arthritis 7. Undifferentiated arthritis a. Fits no other category b. Fits more than one category From Petty RE, Southwood TR, Baum J, et al: Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol 25: 1991–1994, 1998. TABLE 9-4 -- Characteristics of Chronic Arthritis in Children by Type of Onset ... Classification Chronic arthritis in childhood is a complex area of study and investigation, not least because of inconsistencies of definition and terminology. It is genetically heterogeneous, phenotypically diverse in presentation and during the course of the disorder, and substantially without a single pathognomic diagnostic approach. The classification of childhood arthritis has been problematic for decades.[4,][5] In the 1970s, two sets of criteria were proposed to classify chronic arthritis in childhood: those for JRA, developed and validated by a committee of the American College of Rheumatology (ACR),[6] and those for JCA, published by the European League Against Rheumatism (EULAR).[7] Later, a third classification (for JIA) was proposed by the Pediatric Task Force of the International League of Associations for Rheumatology (ILAR).[8] These three classifications are compared in Table 9-5 and Table 9-6. Problems in applying these criteria include the necessity to exclude other diseases for which there are no validated diagnostic or classification criteria for children and the fact that all three were based on populations of northern European derivation. TABLE 9-5 -- Comparison of Classifications of Chronic Arthritis in Children Juvenile Rheumatoid Arthritis (ACR): Systemic Polyarticular Oligoarticular (pauciarticular) Juvenile Chronic Arthritis (EULAR) Systemic Polyarticular Juvenile rheumatoid arthritis Pauciarticular Juvenile psoriatic arthritis Juvenile ankylosing spondylitis Juvenile Idiopathic Arthritis (ILAR) Systemic Polyarticular RF-negative Polyarticular RF-positive Oligoarticular Persistent Extended Psoriatic arthritis Enthesitis-related arthritis Other arthritis ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; ILAR, International League of Associations for Rheumatology; RF, rheumatoid factor. TABLE 9-6 -- Characteristics of the ACR, EULAR, and ILAR Classifications of Chronic Arthritis in Children Код:
Characteristic ACR EULAR ILAR Onset types 3 6 6 Course subtypes 9 None 1 Age at onset of arthritis <16 yr <16 yr <16 yr Duration of arthritis >=6 wk >=3 mo >=6 wk Includes JAS No Yes Yes Includes JPsA No Yes Yes Includes inflammatory bowel disease No Yes Yes Other diseases excluded Yes Yes Yes А еще пару картинок из руководства по РА (Rheumatoid Arthritis, 1st ed., 2008) о заболеваемости РА в США и Великобритании в зависимости от возраста: 
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#17
21.07.2009, 22:47
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Цитата:
Почитала про нее. Написано, что она поражает тазобедренные суставы. А с ними у ребенка все в порядке, вроде.
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#18
22.07.2009, 19:19
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Цитата:
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#20
26.07.2009, 14:46
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"LupusDoc не одобрил(а): "Как правило" - как правило что? Что болезнь Пертеса начинается с болей "проецируемых на коленном суставе"? Это не так.
Timur не одобрил(а): Переведите" Если ссылаться на источник,то слова "как правило" следует заменить на "зачастую": "Клинические проявдения: включают боль(часто боль в колене..." "Clinical Presentation: - includes pain (often knee pain)..." Ссылка: [Ссылки доступны только зарегистрированным пользователям ]
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Линейный вид
