[Prognosis of the systemic forms of juvenile chronic arthritis. Apropos of 100 cases]. / Pronostic des formes systémiques d'arthrite chronique juvénile. A propos de 100 cas.

The records of 100 children presenting with systemic juvenile rheumatoid arthritis were studied retrospectively. The precocity of onset and intensity of initial extra-articular signs did not seem to be correlated with a more severe outcome. On the other hand, the number of arthritides present during the first 6 months seemed to be associated with a different prognosis: the oligo- or abarticular forms generally had a better prognosis. In girls, onset was earlier and remissions were twice more frequent than in boys. Contrary to all other joints, the hip was susceptible of a radiological improvement in 25% of cases. Joint disabilities, especially of the wrist, were initially related to inflammation and pain; secondarily, they were chiefly related to the anatomic evolution, resulting in fusion of the joint spaces. At the last clinical examination after a 10 year's evolution, half of patients were in clinical remission, either without articular sequellae, with sequellae, the most severe of which being the hip involvement; 25% of patients still had systemic symptoms; 25% presented with polyarthritis with persisting biological and articular inflammatory signs.

[Joint prognosis in systemic chronic juvenile arthritis (100 cases)]. / Pronostic articulaire de la forme systémique de l'arthrite chronique juvénile (cent cas).

A retrospective study of 100 cases of systemic juvenile rheumatoid arthritis, including 51 girls and 49 boys, is reported. Follow-up was at least three years in 83 cases, 7 years in 72 of them and 12 years in 20 of them. Patients were included in the study if they experienced high grade intermittent fever for at least two weeks at any time during the course of their disease: thus, patients with delayed fever were eligible whatever the time-interval between onset of the disease and occurrence of fever. The purpose of the study was, indeed, to determine the articular prognosis of the disease according to the overall course rather than to features at onset. Overall results show that clinical involvement of joints occur in the following order: knee 98%, ankle 81%, wrist 77%, cervical spine 70%, elbow 66%, hand 56%, hip 45%, shoulder 29%, foot 10%. In addition, radiologic changes in the temporomandibulary joint are fairly common: 46%. Estimation of these incidences was done 7 years at least after onset. An analytical study was carried out for four joints. At the wrist, very significant findings are regression of inflammatory arthritis (77% before 3 years, 67% after 7 years), progression of bone destruction (19% before 3 years, 67% after 7 years) and stability of permanent stiffness (56% before 3 years, 60% after 7 years) due initially to joint inflammation and subsequently to osseous and fibrous ankylosis. The hip is involved in more than 60% of cases with replacement arthroplasty being considered because of the severity of radiologic destruction in 8% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inflammatory rheumatism in children. Definitions and nosology]. / Les rhumatismes inflammatoires de l'enfant. Définitions et nosologie.

In this critical nosological study of chronic juvenile rheumatoid arthritis, the author opposes his own pluralist concept based on a longitudinal analysis of the overall development to the conventional unicist concept in which the three forms of the disease are regarded as initial presentations of one single entity. The relationship between the systemic form and the abarticular hyperimmune syndromes previously described by Wissler and Fanconi is stressed. Similarities between juvenile rheumatoid arthritis and reactional inflammatory joint diseases of well defined aetiology are discussed; both are considered articular immune reactions to more or less demonstrable antigens. In the absence of specific laboratory tests, the disease can only be defined on clinical grounds. Without being exceedingly wide, this definition should be less restrictive than that based on currently accepted criteria.