The natural course of juvenile rheumatoid arthritis

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THE natural course of juvenile rheumatoid arthritis was studied from the clinical data of 230 patients having this disease. The patients were examined and treaetd at the Cleveland Clinic during the period of June 1952 through December 1968. The mode of onset, the clinical course, and the pattern of the disease were analyzed, and a classification was made conforming to the types of clinical features.

Criteria for diagnosis

The criteria for diagnosis were those of the American Rheumatism Association (A.R.A.) for evaluating adults, and have been modified to conform to the manifestations of juvenile rheumatoid arthritis.1 Of the criteria listed below, 1 through 4 or 4 and 5 are essential for the diagnosis of juvenile rheumatoid arthritis.

  1. Arthritis of one or multiple joints for at least six weeks, or for less than six weeks in the presence of one of the following features: (a) evanescent rash; (b) ankylosis; (c) iritis; (d) flexion contractures; (e) muscular atrophy; (f) anemia; (g) leukocyte count of 18,000 or more per cubic millimeter, without any other identifiable cause; (h) pain or stiffness in the cervical spine, with or without radiographic changes in zygapophysial joints of the neck.

  2. Constitutional symptoms—fever, weakness, weight loss.

  3. Increased sedimentation rate, or increased content of serum glycoproteins and plasma fibrinogen.

  4. Exclusion of rheumatic fever, periarteritis nodosa, systemic lupus erythematosus, dermatomyositis, tuberculous synovitis, lymphoma, and leukemia.

  5. Persistent pyrexia in the absence of any other identifiable cause, gel reaction of 1- to 2-hour duration or longer, at. . .



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