[Management of children with chronic rheumatism. Similarities and differences with rheumatoid polyarthritis]

Abstract

In France, about 3,000 children under 16 years of age suffer from juvenile chronic arthritis (JCA), whose management presents a problem. JCA covers several nosological entities. In 20% of the cases, a systemic form affecting the articulations in an inconstant way, and starting in the very young child, is observed. In 30% of the cases, a form with a polyarticular start is observed. This group is very heterogeneous and includes in particular early seropositive rheumatoid arthritis (RA), the little girls' polyarthritis with presence of antinuclear antibodies, and the little boys' rheumatisms HLA B27. Finally, in 50% of the cases, an oligoarticular form is observed, also expressed in greatly varying ways. In all cases, the evolution is unpredictable and the management of these children is different from that of adults. It must be noted that the treatments used in adults are rarely applied to children as JCA is a pathology which is quite different from RA. Several types of treatment can be administered by general route: non-steroidal antiinflammatory drugs (NSAIDs) and mainly aspirin, since few NSAIDs have a paediatric licence in France. However, the risks of intolerance at doses reaching up to 100 mg/kg are not negligible. Some NSAIDs can be used in older children. The slow acting drugs are dangerous in the systemic form of JCA. Their indication seem to be more appropriate in the polyarticular forms. In the oligoarticular forms, slow acting drugs are rarely proposed. Corticosteroids are prescribed in aspirin-resistant systemic forms only. Besides the complications observed in adults, the growth is stopped in a constant way.(ABSTRACT TRUNCATED AT 250 WORDS)