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目的 探讨幼年型类风湿病患儿的远期预后。方法 对 65例幼年型类风湿病患儿进行门诊、信函或电话随访 ,随访时间为 8～ 1 2 2个月 ,以了解患儿关节的改变及生活质量的情况。结果 65例患儿的分型情况 :全身型 4 4例 ;多关节型 1 6例 ,其中类风湿因子阳性 5例 ,阴性 1 1例 ;少关节型 5例 ,为类风湿因子阴性。本组死亡 2例为全身型 ,死因分别为化脓性脑膜炎和双侧大叶性肺炎。治疗中 ,自行加减药物、未正规抗类风湿治疗者占 60 % ( 3 9/ 65)。 3 5例患儿能正常生活学习。主要并发症 :①关节畸形 1 8例 ,出现于病程的 5～ 4 8个月 ;最常见的畸形关节为膝关节、踝关节。②生长发育迟缓 3 6例 ,患儿出现程度不一的骨质疏松和身高不增。结论 幼年类风湿病的预后与成人类风湿病相比并不乐观 ,早期正规抗类风湿治疗是延缓关节畸形发生的关键 ,同时要加强对患儿生长发育的监控和干预 ,指导家长用药。
Objective To investigate the long-term prognosis of children with juvenile rheumatoid disease. Methods 65 cases of juvenile rheumatoid arthritis patients were followed up by letter, telephone or telephone. The follow-up time ranged from 8 to 122 months to understand the changes of children’s joints and the quality of life. Results The classification of 65 cases of children: systemic 4 4 cases; 16 cases of multi-joint type, including rheumatoid factor positive in 5 cases, negative 11 cases; less joint in 5 cases, rheumatoid factor-negative. The group died of 2 cases of systemic type, the cause of death were purulent meningitis and bilateral lobar pneumonia. Treatment, add and subtract drugs on their own, did not formal anti-rheumatoid treatment accounted for 60% (39/65). 35 children with normal living and learning. The main complications: ① joint deformity in 18 cases, appeared in the course of 5 to 48 months; the most common deformity joint knee, ankle. ② growth retardation 36 cases, children with varying degrees of osteoporosis and height does not increase. Conclusions The prognosis of juvenile rheumatoid arthritis is not optimistic compared with that of adult rheumatoid arthritis. Early regular anti-rheumatoid therapy is the key to delaying the occurrence of joint deformity. At the same time, it is necessary to strengthen the monitoring and intervention on the growth and development of children and guide the parents in their medication.