Juvenile Rheumatoid Arthritis

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The classification system for juvenile inflammatory arthritis (JRA) divides this form of childhood arthritis into three categories: systemic, pauciarticular (four or fewer affected joints), and polyarticular. Among children with JRA, the most important ocular disease is chronic, nongranulomatous anterior uveitis. It occurs in about 20% of children with pauciarticular JRA, 5% to 10% of children with polyarticular JRA, and rarely, if ever, in those with the systemic type. Young girls with the pauciarticular subtype of JRA and a positive test for serum antinuclear antibodies are at the highest risk for developing chronic anterior uveitis. Onset is usually insidious and the children are frequently asymptomatic; this type of uveitis is termed "white eye" because of its benign appearance to the causal observer. The uveitis may precede the arthritis by up to five years. In JRA, chronic anterior uveitis is bilateral in two-thirds of patients. Slit-lamp examination reveals cells and proteinaceous "flare" in the anterior chamber of the eye and/or KP on the posterior surface of the cornea. All children with JRA should be screened for anterior uveitis. According to the American Academy of Pediatrics, the frequency of subsequent examinations depends on the risk levels, ranging from every 3 to 4 months (high risk) to every 12 months (low risk) (11). In one study, asymptomatic uveitis continued into adulthood in almost half of the children (12). In the region of the head and neck, JRA may also cause cervical lymphadeno-pathy and micrognathia due to temporomandibular joint involvement and a bone growth disturbance.

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