Juvenile rheumatoid arthritis (JRA) is basically the same disease as rheumatoid arhritis in the adult. However juvenile rheumatoid arthritis has many features that differ from rheumatoid arthritis in the adult, and since the onset of the disease occurs before the age of puberty, variable alterations in growth may occur. In this study, fifty cases of juvenile rheumatoid arthritis treated at Severance Hospital from January 1970 to December 1977 were analysed clinically and the following results were obtained. 1. By classification, the polyarticular type (46%) was most frequent, followed by the pauciarticular type (34%) and systemic type (20%) in order. 2. The most frequent joint affected was the knee (82%) followed by the ankle (60%), hand (22%), wrist (20%), etc. 3. The extra-articular manifestations on admission were high fever (40%), rash (16%), carditis (14%), lymphadenopathy (14%), etc. 4. Laboratory findings on admission showed increased ESR (88%), positive rheumatoid factor (15.5%), positive ANA (16.6%), etc. 5. Clinical symptoms were managed medically and surgically with aspirin, salicylates and steroids, physical therapy, and synovectomy.
Adolescent ; Arthritis, Juvenile Rheumatoid/classification ; Arthritis, Juvenile Rheumatoid/epidemiology* ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human ; Korea ; Male

OBJECTIVE: Previous classification systems for juvenile idiopathic arthritis (JIA) were based on the number of joints involved and did not categorize homogenous disease entities. Therefore, JIA patients were reclassified retrospectively by applying rheumatoid factor (RF) and antinuclear antibody (ANA), which have been proven to constitute a homogenous disease entity. METHODS: The medical records of JIA patients were investigated retrospectively and reclassified into six categories using the new provisional classification. The nomenclature was based on Dr. Martini's proposal in the 23rd European Paediatric Rheumatology Congress (2016) at Genoa, Italy. New categories included systemic JIA (sJIA), RF-positive JIA (RF-JIA), early-onset ANA-positive JIA (eoANA-JIA), enthesitis/spondylitis-related JIA (ESR-JIA), “other JIA”, and “unclassified JIA”. RESULTS: Of a total of 262 JIA patients, 71 (27.1%) were reclassified as sJIA, 31 (11.8%) as RF-JIA, 22 (8.4%) as eoANA-JIA, 63 (24.0%) as ESR-JIA, 65 (24.8%) as “other JIA”, and 10 (3.8%) as “unclassified JIA”. A comparison of RF-JIA, eoANA-JIA, and ESR-JIA revealed significant differences in the gender ratio, age of disease onset, and the cumulative number and type of joints involved among the three groups. “Other JIA” comprised a significant proportion (24.8%) and warrants the need for further classification. The characteristics of the RF-positive patients were comparable to those of the anti-cyclic citrullinated peptide antibody-positive patients. The ANA positivity was lower (28.2%) than that in Western studies but showed similar clinical features. CONCLUSION: This is the first study applying RF and ANA to classify JIA without considering the joint counts. The six new categories include sJIA, RF-JIA, eoANA-JIA, ESR-JIA, “other JIA,” and “unclassified JIA”.
Antibodies, Antinuclear ; Arthritis, Juvenile ; Classification ; Humans ; Italy ; Joints ; Medical Records ; Retrospective Studies ; Rheumatoid Factor ; Rheumatology

Juvenile rheumatoid arthritis is basically the same disease as rheumatoid arthritis in the adult. However juvenile rheumatoid arthritis has many features that differ from rheumatoid arthritis in adult, and since the onset of the disease occurs before the age of puberty variable alteration in growth may occur. Still, in his classic description of 22 cases of rheumatoid arthritis in children, emphasized the florid form of the disease with fever, lymphadenopathy, and splenomegaly. Since the time of Still many more children with chronic arthriits, which is called Stills disease in England and juvenile rheumatoid arthritis in the United States, have been described, and it has become apparent that the disease has extremely variable manifestations. Forty cases of juvenile rheumatoid arthritis treated at the Severance Hospital from June 1970 to June 1976 were analysed clinically and the following results were obtained. 1. On type classification, the polyarticular type (45%) was most frequent followed by the pauciarticular type (35%) and systemic type (20%) in order. 2. The most frequent joint affected was the knee (77.5%) followed by the ankle (55%), wrist (20%),. elbow (17.5%), etc. 3. The extra-articular manifectations on admission were high fever (42%), rash (20%), carditis (17%) hepatosplenomegaly (12%), etc. 4. Laboratory findings on admission showed increased ESR (85%), positive rheumatoid factor (14.3%),. positive ANA (2.5%), etc. 5. Treatment and drugs were aspirin (57.5%), salicylate and steroid (37.5%), physical therapy (25%), synovectomy (2.5%).
Adolescent ; Adult ; Ankle ; Arthritis, Juvenile ; Arthritis, Rheumatoid ; Aspirin ; Child ; Classification ; Elbow ; England ; Exanthema ; Fever ; Humans ; Joints ; Knee ; Lymphatic Diseases ; Myocarditis ; Puberty ; Rheumatoid Factor ; Splenomegaly ; United States ; Wrist

OBJECTIVE: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. METHODS: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV / I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson' s correlation coefficient were used as statistical methods. RESULTS: Our study show results as follows : (1) Systemic onset type (ll%) { polyarthritis subset (66%), oligoarthritis subset (34%) }, oligoarthritis onset type (62%) { sero (-) -HLA-B27 (+) subset (66%) , RF (+) subset (20%), not otherwise classified subset (14%) ANA(+)-chronic uveitis subset(O%) }, polyarthritis onset type (27%) { RF(+) subset (66%), not otherwise classified subset (34%) }, (2) Sex ratio was M:F=1.8:l. (3) Age of onset was 11+3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11+4.3 years, ANA (0%), HLA-B27 (86%) , 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female (p<0.01) , RF(+) (p<0.01), HLA-B27(-) (p<0.01) , polyarthritis onset type (p=0.02). CONCLUSIONS: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio (male dominance), age of onset (older age) , profiles of HLA-B27 (high positivity in spite of low HLA-B27 positivity in Korean (about 2. 3%) , low rate of destructive change) , ANA (low positivity, older age of onset) , chronic uveitis (low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA) . This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.
Age of Onset ; Ankle ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Blindness ; Classification ; Epidemiologic Studies ; Female ; Hand ; HLA-B27 Antigen ; Humans ; Incidence ; Joints ; Knee ; Male ; Prognosis ; Rheumatoid Factor ; Sex Ratio ; Spondylitis, Ankylosing ; Uveitis