| |
Systemic onset |
Polyarticular RF+ |
Polyarticular RF- |
Oligoarticular |
Extended Oligoarticular |
Incidence (%) Age
Sex
Articular
features |
20-25
Any
F=M
Days to months
later. Mean 3
months. Polyarticular. Large joints
including hip and wrist. Small joints of upper extremity> lower extremity. Cervical spine and t.m. joint less
affected. |
5-7
10 yrs +
F:M 2:1
Small joints of hands and feet,
wrists and
carpals. Ankles and knees also common> 4 joints. Family history of RA in about 25% (may post-date child's illness). |
20-25
10 yrs -
F> M
Rapidly progressive involvement of> 4 joints. Cervical spine and t.m. joint often involved. |
30-35
Peak 1-3 yrs
F:M 4:1
Usually 1-2
joints. Rarely 3-4 Knee,
elbow and
ankle common. Cervical spine and t.m. joint rare. |
10-15
Any
F> M
Onset oligoarticular. By end of first year follows a polyarticular course. |
| Extra articular features |
Classic quotidian
fever. Well
between spikes
should be present at least 2 weeks as a diagnostic
criterion. Truncal evanescent rash
often labeled as drug rash.
Hepatosplenomegaly, adenopathy, pleuritis and
pericarditis (often silent), rarely
pulmonary, cardiac and neurological
features. |
Tenosynovitis common. Subcutaneous nodules on
forearm in
30% Lassitude, fever and
weight loss
rare. |
Low grade
fever in a
third |
Almost none |
Almost none |
Acute
phase
reactants |
Significant elevation.
Polymorphonuclear
response |
Mild elevation |
Normal to
mild elevation |
Normal to mild elevation |
Mild elevation |
| ANA |
Usually negative |
May be
positive |
Positive in a
third |
Positive in 40-75%. Usually in low
dilutions. May develop over
time. Repeat in a year in
negative. |
Similar oligoarticular onset.
|
| RA |
Usually negative |
Strong positive in weeks to
months from
onset. 3
positive results in a year
eliminate other transient positivity states. |
Negative |
Rare (<5%) |
Rare |
| Synovial fluid |
Examination not usually
necessary |
Examination not usually
necessary |
Examination not usually
necessary |
<25000
WBC./cumm polymorph response. Proteins elevated. Glucose within 10% of blood glucose. |
Similar to
oligoarticular onset. |
| Outcome |
Flares may be precipitated by viral and other illnesses. About half
have a
remission at
one year. The rest may have a polyarticular course with
about half of them developing end stage arthritis. |
Chronic arthritis. May
require life-
long therapy. |
Usually good. Requires aggressive management. |
Excellent. Majority have
remission in
one year. |
More severe
course then
those who
remain oligoarticular. Requires aggressive management. |
