Saravanan, M (2011) Outcome of Juvenile Idiopathic Arthritis-Enthesitis related Arthritis. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Juvenile Idiopathic Arthritis (JIA) is defined as arthritis in one or more joints persisting for 6 weeks or more, which begins before the 16th birthday and has no other known cause. Enthesitis Related Arthritis (ERA) is a subtype that has replaced, but is not exactly overlapping with, previous definitions in children such as juvenile ankylosing spondylitis or syndrome of seronegative enthesitis arthritis. ERA is defined as arthritis and enthesitis, or arthritis or enthesitis with at least two of the following: (1) sacroiliac joint tenderness, or inflammatory lumbosacral pain; (2) positive HLA-B27; (3) onset of arthritis in a boy 6 years old or older; (4) acute anterior symptomatic uveitis; or (5) history of ankylosing spondylitis, ERA, sacroiliitis with inflammatory bowel disease, Reiter's syndrome, or acute anterior uveitis in a first-degree relative. In contrast to the western literature only 11-16% of patients with JIA have ERA, In India it is probably the commonest sub type of JIA seen clinically. Data on outcome of ERA patients from India are scarce. This study was taken up to assess the clinical profile and outcome of Juvenile idiopathic arthritis - enthesitis related arthritis. AIMS AND OBJECTIVES : The aim of the study is 1. To study the clinical profile and outcome of Juvenile idiopathic arthritis -enthesitis related arthritis. 2. To study the incidence of Juvenile ankylosing spondylitis. 3. To study the association of HLA_B27 and sacro iliac joint involvement. MATERIALS AND METHODS : The study period was from January 2009 to March 2011. History, clinical examination, radiological imaging like musculoskeletal X-rays, musculoskeletal USG and CT of sacroiliac joints, biochemical investigations and immunological investigations were done for all patients. Material and Selection: Inpatients and outpatients of Department of Rheumatology, Rajiv Gandhi Govt. General Hospital and Madras Medical College, Chennai. The study was under taken after obtaining approval from the institutional ethical committee. An informed consent was obtained from all patients and parents. The study period was from January 2009 to March 2011. Sample size: 50 Study design: Cross sectional study Inclusion criteria are: onset of arthritis before the 16th birthday and persisting for at least 6 weeks; arthritis and enthesitis, or arthritis or enthesitis with at least 2 of; a) Presence of or a history of sacroiliac joint tenderness and/or inflammatory lumbosacral pain, b) Presence of HLA-B27 antigen, c) Onset of arthritis in a male over 6 years of age. d) Acute (symptomatic) anterior uveitis e) History of ankylosing spondylitis, enthesitis related arthritis, sacroiliitis with inflammatory bowel disease, Reiter's syndrome, or acute anterior uveitis in a first-degree relative. RESULTS : The median age at the time of the study of the 50 patients with ERA was 16 years (range 9–33 years) and the median duration of disease was 5 years (3 months–18 years). 49patients were male and one patient was female. Median age at disease onset was 14 (8–15) years. 17(34%) of the patients were HLA B 27 positive. Three (6%) patients were in remission at the time of the study. 15 patients (30%) had joints with limitation of motion. 18 (36%) patients had decreased anterior lumbar flexion movement by modified Schober's method. At the time of the study, all patients were on NSAID; Indomethacin was the most commonly prescribed NSAID. 40 patients (80%) were on it. 21 patients (42%) had received intra-articular (IA) steroid. All patients were on DMARDs at the time of the study. Sulphasalazine was the commonest DMARD used (n = 36, 64%).14 (28%) patients were on Methotrexate. Side effects of drug were seen in 7 patients. GI toxicity in 8 patients. CONCLUSION : Axial inflammation was common in HLA-B27 positive patients. Functional limitations was observed in one third of the Enthesitis Related Arthritis patients. JADI is a useful tool to measure articular and extraarticular damage in ERA. 70% of JIA-ERA patients had enthesitis (Two third of patients had enthesitis).
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Juvenile Idiopathic ; Arthritis-Enthesitis ; Arthritis. |
| Subjects: | MEDICAL > Rheumatology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Aug 2017 00:45 |
| Last Modified: | 16 Aug 2017 06:06 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1814 |
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