CLASSIFICATION CRITERIA OF CHILDHOOD CHRONIC ARTHRITIS

Shumpei Yokota

Dept. of Pediatrics, Yokohama City University School of Medicine, Japan

To establish consistent, internationally acceptable diagnostic nomenclature for children with chronic arthritis, ILAR recently classification criteria with several problems; the classification included arthritis secondary to psoriasis and enthesis, and ANA-positive arthritis was divided into 2 categories though it should be one category with 2 disease patterns, i.e. persistent and extending. For the grown-up children with chronic arthritis the close contact among pediatrician, physician, and orthopedist is needed. However, the classification never pays an attention to adjustment of nomenclature and criteria between childhood and adult chronic arthritis. Moreover, children with systemic arthritis manifest arthritis in the later course of disease or sometimes arthritis is not shown just like adult-onset Still’s disease and they are usually left without diagnosis for several years.

Since the nomenclature of chronic arthritis should be essentially the same through childhood to adulthood, we recommend a new classification criteria which divide chronic arthritis of children into 2 categories; primary and secondary chronic arthritis. The primary chronic arthritis includes juvenile idiopathic arthritis (JIA) and spiking fever-rash-arthritis syndrome. JIA may be subdivided into 3 categories depending on presence or absence of serological markers, rheumatoid factor (RF) and antinuclear antibody (ANA). The secondary chronic arthritis includes psoriasis-related arthritis, spondylo-arthritis or enthesis-related arthritis, inflammatory bowel disease-related arthritis, and reactive arthritis. This classification of criteria is effective to choose treatment regimen depending on the type of arthritis.