Guillaume et al evaluated patients with juvenile rheumatoid arthritis who presented with oligoarticular disease. Some patients have a severe disease with complications, and these patients may benefit from more aggressive management when they present. The authors are from Universite Paris V.
Patient selection: presentation with oligoarticular JRA (with 1 to 4 affected joints)
Joint destruction at presentation ranged from joint space narrowing with or without erosion up to ankylosis.
In the study 50% of patients developed polyarticular disease within 6 years. The authors noted a remission rate of 36% (refer to 23% after 6 years in the abstract).
Risk factors for development of polyarticular JRA (>= 5 joints involved):
(1) involvement of 2 to 4 joints at presentation (HR 2.6)
(2) elevated ESR at presentation (normal < 20 mm in first hour; HR 1.7 if 20 to 99 mm in first hour, 4.4 if >= 100 mm in first hour)
(3) upper limb joint involvement (HR 2.9(
where:
• C-reactive protein (CRP) in theory can be substituted for ESR but only reference point would be upper limit of normal.
Risk factors for joint destruction:
(1) elevated ESR >= 100 mm in first hour at presentation (HR 6)
(2) development of polyarticular disease (10% if oligarticular, 36% with 5 to 9 joints, 60% with >= 10 joints)
Risk factors for uveitis:
(1) family history of psoriasis
