Oligoarticular,Polyarticular, and Systemic Categories: Introduction
Arthritis is a clinical finding of persistent
joint swelling or painful restriction of joint movement. Arthralgia is
pain in a joint, with or without inflammation. Thus, a patient with
arthralgia will not necessarily have arthritis, nor does a patient
with arthritis always have arthralgia. There are many causes of
arthritis and arthralgia in childhood, and this section will be
limited to the chronic arthritides of childhood that have no known
Terminology for this category of disease is problematic: In ongoing
attempts to rationalize the nomenclature, at least three different
classification schemes have been used during the past 20 years (see eTable 201.1). Without a clear-cut understanding
of the pathogenesis or biologic variability of arthritis in children,
however, these systems have often served more to confuse than to
elucidate. Idiopathic arthritis lasting for at least 6 weeks; with
onset before age 16; and not the result of infections, neoplasms,
orthopedic disorders, chronic inflammatory or autoimmune conditions,
or metabolic inherited and endocrine diseases, will be referred
to as juvenile idiopathic arthritis (JIA) in this section. This term
is increasingly used internationally to describe this group of conditions.
Details of the definitions and subcategories within this system are
shown in Table 201-1. The Juvenile Rheumatoid
Arthritis system still used by most caregivers in the United States
is shown in Table 201-2.
eTable 201.1. Classification
System Nomenclature Comparison of Chronic Arthritis in Children |Favorite Table|Download (.pdf)
eTable 201.1. Classification
System Nomenclature Comparison of Chronic Arthritis in Children
|Juvenile Rheumatoid Arthritis ||Juvenile Chronic Arthritis||Juvenile Idiopathic Arthritis|
|• Systemic onset||• Systemic onset||• Systemic arthritis|
|• Polyarticular onset||• Polyarticular onset||• Persistent Oligoarthritis|
|• Pauciarticular onset ||• Oligoarticular onset ||• Extended Oligoarthritis|
|Juvenile rheumatoid arthritis ||• RF-negative polyarthritis|
|Juvenile psoriatic arthritis||• RF-positive polyarthritis|
|Juvenile ankylosing spondylitis||• Psoriatic arthritis|
|• Enthesitis-related arthritis|
|• Undifferentiated arthritis|
Table 201-1. ILAR Classification System for Juvenile Idiopathic Arthritis (JIA) |Favorite Table|Download (.pdf)
Table 201-1. ILAR Classification System for Juvenile Idiopathic Arthritis (JIA)
|JIA is arthritis of unknown etiology that begins before the
16th birthday and persists for at least 6 weeks; other known conditions
including infections, neoplasms, orthopedic disorders, chronic inflammatory
or autoimmune conditions, or metabolic inherited and endocrine diseases.|
|Arthritis in one or more joints with or preceded by fever
of at least 2 weeks’ duration that is documented to be
daily (“quotidian”) for at least 3 days, and accompanied
by one or more of the following: |
|1. Evanescent (nonfixed) erythematous rash |
|2. Generalized lymph node enlargement |
|3. Hepatomegaly and/or splenomegaly |
|4. Serositis |
|Exclusions: a, b, c, d. |
|Arthritis affecting one ...|
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