Objective To investigate the risk factors for pleural lung disease (PLD) in children with juvenile idiopathic arthritis (JIA) and to provide a basis for the early diagnosis and timely treatment of this disease. Methods A total of 360 children with a confirmed diagnosis of JIA were enrolled, and their clinical data were retrospectively analyzed. All patients underwent a chest X-ray. The patients with PLD were assigned to PLD group, while those without PLD were assigned to non-PLD group. The clinical, imaging, and laboratory results of JIA patients with PLD were analyzed. Results Among the 360 JIA patients, 43 (11.9%) had PLD, and 9 (21%) of them had respiratory symptoms. Chest X-ray findings mainly included interstitial pneumonitis (53.5%) and pleurisy and/or pleural effusion (38.1%). In the 43 cases of JIA-PLD, 4 (9.3%) had normal chest X-ray findings but abnormal chest CT findings. The incidence of PLD was relatively high in patients aged under 3 years and those aged 12 years or above. Children with systemic JIA had a relatively high incidence of PLD. Compared with the non-PLD group, the PLD group had a significantly higher incidence of anemia, elevated white blood cell (WBC) count and IgG levels in peripheral blood, and positive rheumatoid factors or antinuclear antibodies (P<0.05). Conclusions Among children with JIA, PLD is mostly seen in patients with systemic JIA or aged <3 years or ≥12 years, especially those with anemia, elevated WBC count and IgG levels, and positive rheumatoid factors or antinuclear antibodies. For JIA patients with PLD, interstitial pneumonitis is usually seen on chest X-ray or CT, but respiratory symptoms are rarely observed. Routine use of high-resolution chest CT is recommended for early diagnosis and timely treatment of PLD in children with JIA.
Key words
Juvenile idiopathic arthritis /
Pleural lung disease /
Imaging /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 何晓琥. 幼年特发性关节炎- 国际风湿病学联盟分类标准讨 论稿[J]. 中华儿科杂志, 2002, 40(4): 254-255.
[2] 卢燕呜, 曹兰芳, 薛海燕, 等. 10 例全身型幼年特发性关节 炎伴肺间质病变的影像学表现分析[J]. 中国医师杂志, 2007, 9(11): 1527-1528.
[3] 赵燕凤, 卢美萍, 陈志敏. 儿童系统性红斑狼疮伴肺胸膜病 变的临床特征分析[J]. 浙江大学学报( 医学版), 2012, 41(3): 327-331.
[4] 李晓红, 舒健翔, 王宏伟. 儿童风湿性疾病的肺部表现[J]. 国 外医学儿科学分册, 2003, 30(6): 333-335.
[5] Leiskau C, Thon A, Gappa M, et al. Lung function in children and adolescents with juvenile idiopathic arthritis during longterm treatment with methotrexate: a retrospective study[J]. Clin Exp Rheumatol, 2012, 30(2): 302-307.
[6] 俞咏梅, 徐亮, 武江, 等. 高分辨率CT 及积分在结缔组织 病并发间质性肺炎及预后中的价值[J]. 中华风湿病学杂志, 2009, 13(12) : 812-815.
[7] Raghu G, Mageto YN, Lockhart D, et al.The accuracy of the clinical diagnosis of new-onset idiopathic pulmonary fibrosis and other interstitial lung disease: a prospective study[J]. Chest, 1999, 116(5): 1168-1174.
[8] Alkady EA, Helmy HA, Mohamed-Hussein AA. Assessment of cardiac and pulmonary function in children with juvenile idiopathic arthritis[J]. Rheumatol Int, 2012, 32(1): 39-46.
[9] Nolan PK, Daniels C, Long F, et al. Severe diffusion capacity reduction in a case of systemic onset juvenile rheumatoid arthritis with mild pulmonary hypertension[J]. Chest, 2005, 128: 435S-436S.
[10] Weiss JE, Lee T, Rabinovich CE, et al. Life-threatening pulmonary hypertension (PH) and alveolar proteinosis (AP) in systemic JIA (sJIA) [J]. Arthritis Rheum, 2008, 58(Suppl): S257-S258.
[11] Sohn DI, Laborde HA, Bellotti M, et al. Juvenile rheumatoid arthritis and bronchiolitis obliterans organized pneumonia[J]. Clin Rheumatol, 2007, 26(2): 247-250.
[12] Watanabe E, Diniz LR, da Mota LM, et al. Pulmonary capillaritis leading to alveolar hemorrhage in a juvenile idiopathic arthritis patient: first description[J]. Rheumatol Int, 2012, 32(6): 1855- 1857.
[13] Gurion R, Lehman TJ, Moorthy LN. Systemic arthritis in children: a review of clinical presentation and treatment[J]. Int J Inflam, 2012, 2012: 271569.
[14] 李彩凤. 巨噬细胞活化综合征诊治进展[J]. 中国实用儿科杂 志, 2010, 25(3): 237-240.
[15] 赵颖, 李菁, 吴庆军, 等. 类风湿关节炎相关肺间质病变的 危险因素、临床和影像学特点[J]. 中华临床免疫和变态反应 杂志, 2012, 6(3): 198-203.
[16] 宋淑菊, 马骥良, 潘丽恩, 等. 类风湿关节炎患者肺问质病 变的临床研究[J]. 中华风湿病学杂志, 2005, 9(2): 81-85.
PDF(960 KB)
