幼年特发性关节炎诊治策略.ppt

幼年特发性关节炎诊治策略
复旦大学风湿免疫过敏研究中心
复旦大学附属儿科医院肾脏风湿科
周利军
fenlin183@
ACR Clinical Classification Criteria for Juvenile Rheumatoid Arthritis
GENERAL CLASSa. Persistent arthritis of at least six weeks duration in one or more jointsb. Exclusion of other causes of arthritis (see list of exclusions+)
onset subtypes-determined by manifestations during the first six months of disease although manifestations more closely resembling another subtype may appear later
Systemic onset JRA*PolyarthritisOligoarthritis
ACR Clinical Classification Criteria for Juvenile Rheumatoid Arthritis
Rheumatic fever
Systemic lupus erythematosus
Ankylosing spondylitis
Polymyositis or dermatomyositis
Psoriatic arthritis
Sjogren's syndrome
Mixed connective tissue disease
Scleroderma
Behcet's syndrome
Reiter's syndrome
Vasculitic syndromes
诊断(ACR)
<16ys
Arthritis 关节炎
6mons subtype analysis
According to new subtypes (JIA)
应做鉴别诊断
ACR Clinical Classification Criteria for Juvenile Rheumatoid Arthritis
Infectious arthritis
Inflammatory bowel disease
Neoplastic diseases including leukemia
Nonrheumatic conditions of bones and joints
Hematologic diseases
Psychogenic arthralgia
Miscellaneous
Sarcoidosis
Hypertrophic osteoarthropathy
Villonodular synovitis
Chronic active hepatitis
Familial Mediterranean fever
ACR Clinical Classification Criteria for Juvenile Rheumatoid Arthritis
Reference: JRA Criteria mittee of the Diagnostic and Therapeutic mittee of the American Rheumatism Association Arthritis Rheum 20(Suppl)195, 1977
幼年特发性关节炎(JIA)
Juvenile Idiopathic Arthritis
Juvenile Rheumatic Arthritis
Juvenile Chronic Arthritis

2001,JIA has been confirmed by ILAR
JIA (ILAR 2001 )
JIA –s
Oligo articular arthritis
Poly RF(+) articular arthritis
Poly RF(-) articular arthritis
Psoriasis
Enthesitis related arthritis
others
ACR /EULAR JIAChronic arthritis
character
JRA
JCA
JIA
Type
3
6
6
Sube type
9
0
1
Age
<16
<16
<16
Persist time
>=6w
>=3months
>=6w
J-SPA