CLINICAL MANIFESTATIONS The signs and symptoms of osteoarthritis depend on the joint or joints affected (see Plate 5-22). Most commonly involved are the weight-bearing joints (see Plate 5-23) and small…

Many factors influence its onset and the speed of joint deterioration, including aging, gender, obesity, heredity, trauma (related to sports or occupation), joint overuse, joint instability, and malalignment. Involved basic…

For children with extended oligoarticular or polyarticular subtypes, weekly administration of methotrexate now stands as the first-line drug of choice. Methotrexate, an antimetabolite, may be administered via the oral or…

The histocompatibility of human leukocyte antigen B27 (HLA-B27) is detected in a large percentage of patients in this subgroup. Children should not be included in this subgroup solely because of…

Ocular involvement of any type is uncommon in patients with the systemic-onset form. Central nervous system (CNS) involvement, including seizures, has been reported but is considered rare. The majority of…

Rheumatoid Factor–Negative Polyarthritis. Approximately 75% of patients with polyarticular-onset arthritis do not have IgM rheumatoid factor in the serum, and the rheumatoid factor test rarely becomes positive 6 months after…

POLYARTICULAR-ONSET ARTHRITIS About 20% to 25% of children with juvenile arthritis exhibit polyarticular onset, which is characterized by involvement of five or more joints and the absence of significant systemic…

In 2004, major changes were made to the classification of children with JIA. Based on expert consensus, children with JIA were subclassified into seven subtypes: oligoarticular (either persistent or extended),…

The leukocyte count helps determine if the joint effusion reflects an inflammatory or noninflammatory process. Synovial fluid is usually heparinized before the cell count to reduce clumping. Leukocyte counts greater…

The clarity of the fluid is assessed by experienced clinicians in the syringe but more reliably can be done by expressing a small amount of fluid out of the plastic…