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目的分析幼年类风湿性关节炎(JRA)的临床特点和诊治措施,为JRA诊治提供参考意见。方法收集本院2002年12月-1210年11月90例JRA患儿的临床资料,对临床表现、辅助检查、治疗方案、随访情况等进行回顾性分析。结果 1.JRA患儿90例中,男65例,女25例;年龄9个月～14岁,其中≤3岁13例,>3～7岁23例,>7～14岁54例。2.全身型JRA 59例(65.6%),多关节型JRA 17例(18.9%),少关节型JRA 14例(15.5%);3种类型病例≤3岁分别为10例、2例、1例,>3～7岁分别为18例、3例、1例,>7～14岁分别为31例、12例、11例,不同年龄组与JRA各类型发病情况的差异无统计学意义(Pa>0.05)。3.JRA临床症状较复杂,以发热、关节肿痛、淋巴结大、皮疹为主要临床表现,全身型JRA 6例伴浆膜腔积液,4例伴肺部浸润;未发现虹膜睫状体炎。4.类风湿因子(RF)、抗核抗体(ANA)及HLA-B27阳性率分别为7.8%、8.9%和24.4%;血常规、ESR、CRP、免疫球蛋白、T淋巴细胞亚群等检查异常。5.单用非甾体类抗炎药(NSAIDs)治疗18例,72例予NSAIDs+甲氨蝶呤(MTX)或柳氮磺胺吡啶(SASP),体温控制不佳加用糖皮质激素,87例症状减轻。6.共随访26例患儿,随访5个月～6 a。规则治疗组6例,无症状及关节畸形;不规则治疗20例(17例自行停药,3例不规则治疗),15例无症状,3例仍有反复发热,2例遗留关节畸形。结论 1.JRA是儿童时期较常见的与自身免疫功能紊乱密切相关的慢性关节炎,在婴幼儿、学龄前期、学龄期均可见到全身型、多关节型、少关节型。2.JRA诊断主要依靠临床特征,强调排除其他系统疾病。辅助检查用于除外其他疾病及了解疾病活动性,但无确诊意义。3.JRA应长期规范联合治疗,不规范治疗可能影响预后。
Objective To analyze the clinical features, diagnosis and treatment of juvenile rheumatoid arthritis (JRA) and provide reference for the diagnosis and treatment of JRA. Methods The clinical data of 90 JRA children from December 2002 to November 2010 were collected retrospectively. The clinical manifestations, auxiliary examinations, treatment plans and follow-up were retrospectively analyzed. Among 90 cases of JRA, there were 65 males and 25 females, ranging in age from 9 months to 14 years, of whom 13 were ≤3 years, 23 were from 3 to 7 years and 54 were from 7 to 14 years. There were 59 cases (65.6%) with systemic JRA, 17 cases (18.9%) with multiarticular JRA, and 14 cases (15.5%) with less articular JRA. Three types of cases were ≤3 years old, 10 cases, 2 cases, 1 case Cases,> 3 to 7 years old were 18 cases, 3 cases, 1 case,> 7 to 14 years were 31 cases, 12 cases, 11 cases, different age groups and JRA various types of morbidity was not statistically significant ( Pa> 0.05). JRA clinical symptoms more complex, with fever, joint swelling and pain, lymph nodes, rash as the main clinical manifestations, systemic JRA 6 cases with serosal effusion, 4 cases with pulmonary infiltrates; no iridocyclitis was found . The positive rates of RF, ANA and HLA-B27 were 7.8%, 8.9% and 24.4% respectively; The blood test, ESR, CRP, immunoglobulin and T lymphocyte subsets abnormal. 18 cases were treated with NSAIDs alone, 72 cases were treated with NSAIDs + methotrexate (MTX) or sulfasalazine (SASP), body temperature was poorly controlled with glucocorticoid, and 87 cases Symptoms are relieved. A total of 26 children were followed up for 5 months to 6 years. There were 6 asymptomatic and joint deformities in the treatment group, 20 in the irregular treatment group, 17 in the treatment group and 3 in the irregular treatment group. Fifteen asymptomatic patients were still asymptomatic. Three patients still had recurrent fever and two had residual joint deformities. JRA is a common childhood chronic autoimmune disorders are closely related to chronic arthritis, infants, preschool, school age can be seen in the whole body, multi-joint type, less joint type. 2.JRA diagnosis depends mainly on clinical features, emphasizing the exclusion of other systemic diseases. Auxiliary examination for the exclusion of other diseases and understanding of disease activity, but no diagnostic significance. 3.JRA should regulate long-term combination therapy, non-standard treatment may affect the prognosis.