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Rheuma bei Kindern und Jugendlichen

Juvenile idiopathische Arthritis (JIA)

Juvenile idiopathic arthritis (JIA)

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Zusammenfassung

Die JIA ist eine häufige Ursache der chronischen Gelenkentzündung bei Kindern und Jugendlichen. Differenzialdiagnostisch müssen andere Ursachen und Systemerkrankungen ausgeschlossen werden. Eine ausführliche Anamnese, ein gründlicher Untersuchungsbefund und einige, wenige gezielte Laboruntersuchungen erlauben die sichere Zuordnung zu 1 der 7 JIA-Subtypen. Die körperliche Untersuchung beinhaltet die Inspektion, Palpation und Funktionsprüfung der Gelenke nach Neutral-0-Methode. Krankheitsaktivität und Therapieresponse werden nach standardisierten Kriterien erfasst [VAS (visuelle Analogskala), CHAQ (Child Health Assessment Questionnaire), ACR-Kriterien (ACR: American College of Rheumatology)]. Patienten mit JIA sollen interdisziplinär betreut werden, wobei insbesondere regelmäßige augenärztliche Kontrollen erforderlich sind. Es stehen medikamentöse und nichtmedikamentöse Behandlungen zur Verfügung. Erstere umfassen vorwiegend die Gabe nichtsteroidaler Antirheumatika, lokale Steroidinjektionen und den Einsatz von Methotrexat entsprechend den Therapieleitlinien. Zusätzlich kommen Immunsuppressiva oder Biologika zum Einsatz. Die Prognose variiert nach JIA-Subtyp und ist bei Oligoarthritiden am besten.

Abstract

Juvenile idiopathic arthritis (JIA) is an important cause of chronic joint inflammation in children and adolescents. Detailed evaluation of the patient history, a complete physical examination and some lab tests lead to the sub-classification into 1 out of 7 JIA subtypes. Other systemic diseases or secondary causes arthritis have to be excluded. Physical examination of the joints includes inspection, palpation and testing the range of movement. Disease activity and treatment responses should be evaluated following standardized criteria, e.g. visual analogue scale (VAS), child health assessment questionnaire (CHAQ) and the American College of Rheumatology (ACR) criteria. An interdisciplinary approach is mandatory. JIA patients should be seen frequently by an ophthalmologist and treatment should follow evidence and consensus-based guidelines including drug therapy and other treatment modalities. Drugs regularly used in the treatment of JIA are, non-steroidal antirheumatic drugs, methotrexate and intraarticular corticoid injections. The prognosis of JIA varies depending on the subtype.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Gregor Dückers hat Reisekosten von den Firmen Novartis und Baxter erstattet bekommen. Tim Niehues hat Honorare und Unterstützung zu Veranstaltungen von den Firmen Abbott, Essex Pharma, Novartis, Pfizer und Wyeth erhalten.

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  1. Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland

    G. Dückers & T. Niehues

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Correspondence to G. Dückers.

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Dückers, G., Niehues, T. Rheuma bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 159, 25–33 (2011). https://doi.org/10.1007/s00112-010-2263-8

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