Polyarticular Juvenile Arthritis (ICD-10: M08.3, seronegative type, M08.0, seronegative or seropositive)
Polyarticular Childhood Arthritis (Polyarticular JIA) includes all children with joint inflammation at least 5 different swollen joints (polyarticular arthritis) during the first 6 months of the disease. This form of childhood arthritis can be divided into them without detectable rheumatoid factors (RF, CCP) («seronegative») and the with rheumatoid factors ("seropositive").
- Arthritis (polyarthritis) without rheumatoid factors (seronegative)
This type includes 30% of juvenile arthritis cases and has a girl: boy incidence of 3: 1
- The disease usually debuts in 6-12's age
- All children have at least 5 inflammed joints within the 6 first months from disease start
- Uveitis (inflammation of the eye) can cause permanent damage with reduced vision) occurs in 10%, and the blood test ANA which increases the risk of eye damage is detected in 40%
- Signs of inflammation can be seen in blood tests such as c-reactive protein (CRP) and blood loss reaction (SR), but they are often only slightly elevated
Jaw joints can be attacked, which can lead to reduced gaping ability. In the long run, the lower jaw may grow smaller and become somewhat retracted. In addition to clinical examination, ultrasound and MRI will show if there is arthritis in the jaw joint.
- Joint inflammation (polyarthritis) with rheumatoid factors
- Occurs at less than 10% among those with childhood arthritis
- Girl: boy incidence is a whopping 9: 1
- The disease may look similar to Rheumatoid arthritis in adults
- Blood tests often show slightly elevated blood pressure response (SR) and CRP, as well as the presence of rheumatoid factors (RF, CCP)
The aim of the treatment is to achieve absence of fever, joint inflammation, permanent joint injury, damage to the eyes and internal organs. The treatment should at the same time alleviate pain and contribute to as normal upbringing as possible.
- Non-medical treatment including physiotherapy is combined with drugs
- NSAIDs (ibuprofen, naproxen) have some effect, but must usually be combined with disease-modifying other medications
- Methotrexate (tablets or injections) are useful for most people with polyarticular juvenile arthritis.
- Methotrexate reduces disease activity and thus pain, stiffness and development of joint damage.
- The effect occurs during 2-3 months and lasts as long as one uses the drug.
- Although cortisone preparations are avoided as far as possible, often need to be done Prednisolone (tablets) used over a period of time.
- If necessary, one can Biological medicine added, of which TNF inhibitors are the first choice.