CLINICAL ANALYSIS OF 570 CASES WITH JUVENILE RHEUMATOID-ARTHRITIS - RESULTS OF A NATIONWIDE RETROSPECTIVE SURVEY IN JAPAN

The purpose of the present study was to investigate the incidence of j uvenile rheumatoid arthritis (JRA) among Japanese children and to eval uate the clinical features of this disease. A questionnaire was sent t o the department of pediatrics of 1290 hospitals in Japan, in 1994, as king for the number of rheumatic patients during the past 10 years. Su bsequently, a second questionnaire was sent asking for the type of ons et, clinical features, treatment, and other details. The results of 57 0 cases were obtained. Of these, 310 cases (54%) were the systemic ons et type, 140 cases were the polyarticular onset type (25%), and 120 ca ses (21%) were the pauciarticular onset type. Hence, in the present se ries of children, the proportion of the pauciarticular type was less t han the other two types of JRA. In the laboratory findings of the syst emic onset type, hyperferritinemia and thrombocytosis were noted, in a ddition to leukocytosis, positive C-reactive protein (CRP) and accentu ated erythrocyte sedimentation rate (ESR). The rheumatoid factor was p ositive in 50% of patients with the polyarticular onset type. Chronic uveitis was recognized in 13 cases (10.8%) of the pauciarticular onset type. In four girls, uveitis started before the onset of arthritis. N onsteroidal anti-inflammatory drugs were used in almost one-third of c ases, and methotrexate (MTX) was used in 12.8% of cases. The quality o f life of children with JRA was disturbed in almost 20% of cases. Ther efore, for the early and definitive diagnosis of the systemic type of JRA, diagnostic procedures including thrombocyte counts and serum ferr itin level, should be performed. In order to obtain good results and t o avoid side effects, a protocol for the use of disease modifying anti -rheumatic drugs and immunosuppressants, especially for the use of MTX , must be established.