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Abstract

Naidu et al raise an important point, because both family and physician want to know what will happen to the children presenting with pauciarticular arthritis over the ensuing years. We are presently analyzing the 3-year follow-up data on our 215 patients. A major problem arises with the definition of progression to polyarticular disease because there exists, to our knowledge, no empiric evidence that 5 joints with arthritis are biologically different from 4 such joints or that the final outcome is any different. The definition of polyarticular disease, in our minds, might be better defined as over 10 joints with arthritis, although this is an arbitrary bias of ours. Only one of the 215 children with pauciarticular arthritis in our study progressed to have widespread arthritis, that is, 31 joints involved with arthritis. This child only had bilateral knee arthritis at 6 months into her illness. Another child later developed arthritis in 14 joints. Additionally, 24 children developed arthritis in up to 9 joints over the ensuing 3 years. Of these 26 children, 14 had small hand joint involvement (P < .0001, Fischer exact test, 2-sided). The increased frequency of the development of arthritis in more than 5 joints in children with small hand joint disease may be related to the fact that there are many more small joints of the hands than there are larger joints. There may also be an intrinsic difference between those with and without small joint hand arthritis, although in our study the prevalence of uveitis was not different between those with small versus large joint arthritis. Therefore, the biologic and prognostic significance of initial small joint arthritis is probably minimal but warrants further study. We agree that the delay in diagnosis is a problem, but it can be remedied by physician awareness.