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Ethiopathogenetic, clinic and therapeutic considerations in juvenile chronic arthritis

Author: Ninel Revenco
Degree:doctor habilitat of medicine
Specialities: 14.00.06 - Cardiology and Reumatology
14.00.09 - Pediatrics
Scientific consultant: Liliana Groppa
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council:


The thesis was presented on the 30 October, 2007
Approved by NCAA on the 20 December, 2007


Adobe PDF document0.69 Mb / in romanian


CZU 616.72-002.2-053.2-08

Adobe PDF document 2.28 Mb / in romanian
199 pages


juvenile chronic arthritis, ethiopathogenie, clinical symptoms, laboratory analysis, immune-genetic system, correlation beginning-development, foreseeable factors, methotrexate, sulphasalazyne


During the initial stage 707 children with ages ranging from 13 to 192 months (with medium age of 128.7±55.3 months) with articular syndrome have been evaluated. The evaluation was many-sided and was directed to perform the differentiated diagnosis in order to elaborate on the causes of articular pains. Consequently, children with JIA have been selectively evaluated according to ACR criteria. The analysis of these children was focused on three main issues: 1) the stage of evaluation of incipient paraclinic characteristics; 2) the analysis of correlation beginning–development of JIA; and 3) the treatment stage of the analysis (the treatment lasted for 24 months and consisted of methrotrexate vs sulphasalazyne). The systemic type was found in 13.0% of children, the poliarticular type in 30.4% and the oligoarticular type in 56.6%. JCA can evolve at any age, but the debut stage is ascertained to be at the age of 7-9 and 11-13 with its peak at the age of 14-16. JCA in association with articular affections provokes general manifestations and affections of various systems of the body that modify some types of the disease. These changes are almost always related with the systemic type and seldom with the poliarticular form. It is worth mentioning that they can also be present in the poliarticular form, but the frequency and the degree of this appearance are minor. The eye affection was present in 18.8% of JCA cases. The uveitis is generally associated with the oligoarticular form (82.1%) and it affects girls in particular (75.9%). It is not related with the systemic form. The clinical signs of uveitis were the first manifestation of the disease following those of articular affection in 12.8% of children. JCA is associated with changes of the immune-genetic status that might play an important role in the pathogenie of the disease. The results would fit the ethiopathogenetic scheme in the following manner: in a body with a particular genetic sensibility (the presence of HLA A2, DR2, DR1 and A3 antigenes), the influence of environmental factors like ones of an infectious type, various forms of articular traumas or seldom - insolation (in 2.8%) that might cause the launch of the autoimmune mechanism manifested through a disbalance of immunocompetent cells caused by the the deficit of T-suppressors, by the reduction of the coefficients of T-helpers/T-helpers and by the increase in the concentration of IgG and IgM and immune circular systems. The grave forms of JCA with articular destructive elements have an insidious beginning. On the other hand, JCA is a disease that causes serious affections even from its beginning. In this way, the insidious debut evolved clinically unfavourably in 32.0% of children and articular destructively in 45.5% while the severe debut of JCA concluded in clinical remission in 39.2% of children and in articular radiology in 40.0%. The total proportion of those excluded from the analysis was greater after 6 months of treatment (methotrexate – 40,0% vs. sulphasalasyne – 43,0%) than after two years of treatment (methotrexate - 18% vs sulphasalasyne - 23%). The side effects and the lack of compliance with the treatment were the primary causes of the exclusion of patients from the research of methotrexate and sulphasalasyne sections. The side effects were a less important cause in the methotrexate section of the research than in the sulphasalasyne one. Both methotrexate and sulphasalasyne are efficiently prepared in comparison with placebo for the treatment of JCA. The effects of the treatment are visible after six months of administration and their positive effects are emphasized after 12 and 24 months. Similar results were reached in the treatment with methotrexate and sulphasalasyne after 6 and 12 months. After 24 months of treatment, methotrexate was found to be more effective than sulphasalasyne with the percentage of responders to ACR20 of 82% vs. 60% (p<0.001) and of responders to ACR50 of 32% vs. 25% (p<0.005). consequently, methotrexate might be the primary option for the base treatment of JCA related symptoms. The discriminatory statistical analysis emphasized the foreseeable factors at the debut of the disease that might influence the clinical and articular evolution of JCA.