Juvenile rheumatoid arthritis persisting into adulthood

Abstract

Forty-six adults whose rheumatoid arthritis commenced in childhood were studied. Their disease appeared similar to adult-onset rheumatoid arthritis, most patients having symmetrical polyarticular disease, but there were minor clinical differences, including localized growth disturbances (micrognathia, small deformed feet) and a rarity of rheumatoid nodules (four of forty-six patients). Severe hip disease (eighteen of forty-six patients) was a major debilitating feature. Monoarticular and pauciarticular arthritis rarely persisted as such with long-active disease; in nine of fourteen patients with these types of onset polyarticular disease had developed by the time of study. Systemic manifestations, common in childhood juvenile rheumatoid arthritis, were uncommon in this group of adult patients. There was a high frequency of roentgenographic abnormalities of the hands (thirty of forty-four patients), wrists (thirty of forty-four patients), cervical spine (twenty-four of forty-four patients), sacroiliac joints (nineteen of forty-four patients) and hips (eighteen of forty-four patients). Abnormalities of the hips, cervical spine and sacroiliac joints were associated with polyarticular disease and functional impairment. Tests for rheumatoid factor were positive in thirteen of forty-six patients, usually in those with onset of the disease in late childhood. There was no relationship between the presence of rheumatoid factor and age of the patient at study, or duration or severity of disease. Many patients with active arthritis in adulthood were seronegative. The course of disease was highly unpredictable. Eleven patients with apparently mild disease in childhood had severe exacerbations in adulthood after years of symptom-free remission. Patients with active disease continued to have involvement of new joints in adulthood. Despite long-active disease, however, thirty-five of forty-six patients retained relatively good function at the time of study. No evidence was found from this study to suggest that juvenile rheumatoid arthritis is a different disease from adult-onset rheumatoid arthritis; patients with juvenile rheumatoid arthritis persisting into adulthood come to resemble closely those with the adult-onset disease.