The Pauciarticular juvenile rheumatoid arthritis is a procedure characterized by the existence of chronic joint inflammation in children less than 16 years. It is the most delegate disease of pediatric rheumatology. Its significance is conditioned not only by its high occurrence much advanced than detected in our environment but also by the changes are continually occurring in its, classification, concept and therapeutic modalities.
The general characteristics include the presence of chronic synovial inflammation of the joints. The presence of rheumatoid factor is antinuclear antibodies, antibodies against the hot shock proteins. As with other autoimmune diseases, it presents relations with genetic markers, particularly with the major histocompatibility complex of the short arm region.
Concept and classification
There are different opinions regarding clinical criteria and classification. These differences exist even in the nomenclature. Within juvenile idiopathic arthritis, 7 entities would be included:
- Systemic arthritis
- Polyarthritis with negative FR
- Polyarthritis with positive FR
- Oligoarthritis extended
- Arthritis-related to enthesitis
- Psoriasis arthritis
It is the most ordinary connective tissue disease in children. The rheumatic process most often motivates hospitalization in our environment. This contrasts with the general perception that it is a rare disease in our environment. That probably has to be attributed to the low degree of suspicion, which would motivate the existence of undiagnosed cases. The age of appearance is changeable, observing two peaks of higher incidence, one between 2 and 5 years and another in the second decade of life in the last group there is a higher prevalence of males.
Family cases appearance has been described it is not general to find a family history of the process. The most number of familial cases occurs in the oligoarticular form. Genetic factors influence clearly, as it happens in other autoimmune diseases. The most involved genes are those that modulate the HLA antigen fixative (Ag) its appearance to the receptors (TCR) of the T lymphocytes.
The systemic form corresponds to what is known classically as Still’s disease. It is one of the least frequent, affecting about 10-20% of children with YMCA. It can happen at any age, it is more common below 6 years of age. The process is accompanied typically by fever and general condition. In up to a third of cases, joint symptoms may be absent at the beginning, with weeks, months and even years after the start of the generalized participation. This makes the clinical diagnosis difficult at least primarily since for it to be ultimate, the presence of arthritis is essential. The general symptoms, which tend to be more intense the lower the patient, anorexia consist of, asthenia, fever, fatigue or irritability.
- It is frequently essential a multidisciplinary therapeutic move toward that include not only the pediatrician but also specializes in occupational therapists, rehabilitation, and physiotherapy, nurses social workers, etc. The most vital is the child himself and his family. Since adherence to medical treatment and rehabilitation is essential for good control of the disease.
- The therapeutic of the set of diseases called ACJ ARJ, or JIA has changed markedly in recent years. The traditional treatment scheme was based on the therapeutic pyramid. That consisted of the sequential use of drugs of increasing toxicity depending on the clinical response of the patient.
- Try to start with the simplest drug and with fewer side effects, restricting the use of the most aggressive medications. At the base of this therapeutic pyramid were less destructive treatments such as non-steroidal anti-inflammatories and physiotherapy and at the apex of it the experimental therapies.
- Naturally, only two major therapeutic resources were available for the treatment of YMCA: acetylsalicylic acid and corticosteroids. At present, the therapeutic arsenal has increased notably with the inclusion of various immunosuppressive agents and new anti-inflammatory.
Therefore, the major advances in the treatment of the disease in the last 10 years. The development of new non-steroidal will be anti-inflammatory drugs (NSAIDs) with greater potency and fewer side effects.