Clinic and Prognosis of Rheumatoid Arthritis in Children

Abstract

Summary A series of 90 cases of rheumatoid arthritis in children below 15 years, treated in the Rheumatological Department of the University Hospital, Lund, Sweden, before 1951 were re-examined after an interval of at least 5 years. The material contained more than twice as many girls as boys, namely 70 per cent and 30 per cent respectively. Typical Still's disease was uncommon (5 cases). Involvement of the larger joints, particularly knee joints, at the onset was more frequent than in adults. The process often began as monarthritis. In girls above 12 years, the involvement of small joints tended to become as frequent as in adults. In addition to the arthritic symptoms, the onset is marked by insidious subfebrility, a moderate increase in the E.S.R., moderate hypochromic anemia and eosinophilia as well as signs of myocardial injury. Skin and ocular manifestations are common. Peritendinitis and subcutaneous nodules are sometimes seen. There is often a marked tendency to flexion contractures. Movement treatment, plaster bandage, pin-traction, and joint splints are therefore important to avoid permanent defects and invalidity. In the present series internal therapy still consisted mainly of chrysotherapy as well as salicylic preparations — antihistamines and more modern hormone treatment. Blood transfusions were often used. Since the recent introduction of hormone therapy this treatment has been the rule in the management of typical cases of Still's disease. The prognosis appears to be relatively good — except for the cases of Still's disease occurring before the introduction of hormone treatment. Of the 85 cases, 53 (62 per cent) were symptom-free at the time of the re-investigation, 16 (19 per cent) had healed defectively but the patients were working at full wages, 11 (13 per cent) had died or were invalids and in 5 the morbid process was still active. Of the 5 patients with Still's disease, 3 had died or were invalids and 2 — from the time of hormone treatment — were in a good condition. Protracted care in hospital is necessary, preferably in rheumatological departments. The advance seen in the much better prognosis of today, is not so much a better internal treatment; it is chiefly the long good hospital care with perfect kinesotherapy and rehabilitation of joint and limb function. Remarks. — These cases were treated in hospital before 1951. In the last 5 years hormone treatment has been widely used. Yet, judging by the results hitherto achieved, hormone therapy has not produced any improvement in the prognosis.