003 Juvenile idiopathic arthritis: a series of 22 cases

Abstract

Abstract Introduction Juvenile Idiopathic Arthritis (JIA) is a group of conditions in which the first sign of the disease appears before the child's 16th birthday. The common feature is the presence of at least one arthritis of > 6 weeks’ duration with no recognized aetiology. JIA affect approximately one child in 5000 before the age of 16. Materials and Methods This is a retrospective study of 22 cases of juvenile idiopathic arthritis from the department of pediatrics at the Mohammed VI University Hospital in Oujda seen over a period of four years and 7 months (January 2014 to August 2018). Results The patients were 10 girls and 12 boys aged from 1 to 13 years. The hospital frequency of this disease was 0.49%, six clinical forms of onset were seen: 8(36%) had systemic onset JIA, 5(23%) had Oligoarticular JIA, 2(9%) had rheumatoid positive polyarticular JIA, 3(14%) had rheumatoid negative polyarticular JIA, 2(9%) had enthesitis related arthritis, and 2(9%) had undifferentiated arthritis. The diagnosis was based on clinical, biological, radiological and evolutionary elements. The biologic inflammatory syndrome was present in almost all patients in our series. Anti-nuclear antibodies were positive in two cases of polyarticular JIA and rheumatoid factor was positive in 10% of our patients. 25% had radiological features: one patient was classified as Steinbrocker stage I and the second with systemic JIA as stage III. Two other patients with oligoarticular JIA had small joint effusion and fixed flexion deformities. The treatment was with non-steroidal anti-inflammatory drugs, corticosteroids, salicylates and disease modifying anti-rheumatic drugs which were methotrexate in 47% of cases, and biotherapy in 9% of them. Outcome was favorable in most of the patients, but 31% developed complications which were: growth retardation (2), joint deformities (1), and iatrogenic complications of medical treatment (4). The variability of the outcome reflects the extreme heterogeneity of clinical forms of JIA. Conclusion The treatment of a child with JIA cannot be conceived outside of a multidisciplinary pediatric team. The treatment includes medication and measures to maintain a good functional state of the joints, notably rehabilitation and surgery. The biotherapies have revolutionized the therapeutic approach to JIA, with a notable effect of these new molecules, particularly anti TNF, anti-IL 1 and anti-IL 6.