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The authors studied the response to and side effects of long-term glucocorticoid (GC) therapy of systemic juvenile rheumatoid arthritis (SJRA). GC were given to 24 girls and 9 boys at the age of 4 to 15 years with classic SJRA in a mean dose 1.6 +/- 0.13 mg/kg (24.0 +/- 0.55 mg/day) for 6.3 +/- 0.55 years, on the average. Mean duration of the disease was 7.1 +/- 0.55 years. 94% of the patients had lymphaticohypolastic constitution. Long-term GC monotherapy in a dose 0.2-0.5 mg/kg/day failed to control a SJRA course and to produce an immunosuppressive effect while side effects were severe: inhibition of activity of the hypothalamohypophysioadrenal system and resultant hormone dependence (100%), Cushing's syndrome (97%), nanism (85%), osteoporosis (64%), secondary infections (58%), aseptic necrosis of heads of the femur (52%). Oral GC treatment is not effective as first-line therapy of SJRA. It should be used as adjuvant to immunodepressants. Intraarticular and/or intravenous administration is preferable.

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Preparations of intravenous immunoglobulin (sandoglobulin, pentaglobin, intraglobin F, octagam) were given daily or each other day in a course dose 0.3-1 g/kg to 43 patients aged 4 to 15 years. Eight of them had allergosepsis, 22--allergoseptic variant of juvenile rheumatoid arthritis (JRA) and 13--systemic JRA and generalized joint syndrome. The treatment induced remission in patients with allergosepsis, prednisolone was discontinued. JRA patients coped with fever, eruption, polyserositis, infection symptoms. Leukocyte count normalized. Preparations of intravenous immunoglobulin in low doses can be therapy of choice in patients with rheumatic-like diseases. In JRA patients it can be effectively used against fever, eruption, polyserositis, carditis, leukocytosis, intercurrent infection before or in the course of immunosuppressive therapy.

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AIM: To develop an effective and safe therapeutic policy for Sandimmun-Neoral in order to prevent joint destruction, invalidation, achieve higher life quality in patients with systemic juvenile rheumatoid arthritis (SJRA). MATERIALS AND METHODS: The trial included 26 patients with SJRA aged 4-15 years. 12 of them had early SJRA, 14--late SJRA. 13 patients received Neoral for one year and the other 13 for 2-3.5 years. Markers of aggressive SJRA course in the debut were registered in all the patients. Previous treatment incorporated nonsteroid antiinflammatory drugs, intraarticular corticosteroids (all the patients), prednisolone (19 patients), methotrexate (3 patients). Before Neoral treatment 80% of the patients had structural alterations in the joints, signs of invalidation, low quality of life. SJRA activity was defined as the 3d degree. All the patients suffered from obesity, hypertrichosis, steroid spondylopathy, nanism. RESULTS: Neoral recovered joint motility in 30% of patients, 60% were capable for self-service. Quality of life was assess as high in 80%, moderately reduced--in 20%. 35% of the patients achieved clinico-laboratory remission. The disease activity dropped to degree I-II in 65% of patients. Structural changes in the joints stopped progressing in 77%, regress of the anatomic stage was seen in 20% of patients. Prednisolone was discontinued in 7 and dose-reduced in 6 patients. Exogenic hypercorticism relieved and growth resumed in all the patients. Neoral proved effective both in early and late SJRA, inhibited destruction both in patients in remission and in active disease. Side effects were: hypertrichosis in 13 patients, moderate blood hypertension in 1 case. CONCLUSION: Neoral can control the disease. It is indicated both in early and late SJRA in the presence of aggressive course markers, acute coxitis with aseptic necrosis of the head of the femur or free of it. Neoral treatment should be started as early as on the first year of the disease, before the structural changes in the joints. For safe long-term therapy it is valid to give cyclosporin A in monotherapy or in combination with voltaren in minimal doses. Corticosteroids are used on demand. The preference should be given to intraarticular or intravenous prolonged drugs but not oral prednisolone which may course such severe complications as obesity, hypertension, nanism.

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AIM: To ascertain criteria of aggressive course of juvenile rheumatoid arthritis (JRA) during 6-12 months since the disease onset, to measure the rate of destruction progression, to formulate indications for conduction of early immunosuppressive therapy. MATERIALS AND METHODS: The study included 30 patients (21 girls and 9 boys) aged 4-15 years with classic JRA. 25 children (76.2%) had systemic, 5 children--articular disease (23.8%). RESULTS: 50% and 20% of the examinees got the disease before they reached the age of 5 years and in puberty, respectively. Severe systemic disease in the debute was registered in 83.3% of patients, 16.7% developed primarily articular JRA. For 1 year the disease transformed into generalized and polyarticular in 43.3% and 56.7% of patients, respectively. Its activity reached the third degree in all the patients. IgG levels exceeded the age standards 1.5 times. Articular dysfunction occurred in 100% of the cases. Destruction in the joints was recorded in 37% and 92.5% of patients after 1 and 2 years of the disease, respectively. CONCLUSION: Early or in prepuberty, puberty onset of JRA, systemic variants of the debute, debute by classical seropositive RA without systemic symptoms, fast appearance of symmetric, generalized joint lesions, recurrent course with high ESR, C-reactive protein, IgG, growing joint functional insufficiency within the first year of the disease may severe criteria of aggressive course of RA in children. RESULTS: The presence of the above markers in RA patients is indication for administration of the disease-controlling drugs within the first 12 months before development of anatomic destruction and the patients' invalidation.

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Clinico-morphological study of the gastroduodenal system and also morphometric investigations of the degree of gastroduodenitis activity and the condition of the local immune system were made in 30 children aged from 4 to 15 years with juvenile rheumatoid arthritis (JRA). Microbiological, histological and electron microscopic methods for revealing Campylobacter pylori (CP) were used. Interrelationship between various clinical manifestations of JRA with the nature of gastroduodenal system affection and with the incidence of microbial colonization of SP was determined. All the patients with JRA had lesions in the gastric and duodenal mucosa, and some morphological features were revealed in them. SP was diagnosed in 86.7 per cent. There was a relation between the microbial clonization of SP and the degree of the rheumatoid process activity. It is suggested that SP does not play an etiological role in the development of gastroduodenitis in JRA but may serve as a pathogenetic factor in the development of an erosive-ulcerous lesion.

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The authors submit the results of echographic investigation of 42 children aged from 4 to 15 years old with juvenile rheumatoid arthritis (JRA). All the patients were distributed into three groups. Signs of affection of the hepatobiliary system were revealed in 60% of the patients, predominantly with the articular form of the disease and in 78.5% of the children with the articular -visceral form. The most grave changes were noted in the group of patients with JRA complicated by secondary amyloidosis (100%). The data obtained are compared with the clinico-laboratory indices, the form of the disease, peculiarity of therapy as a result of which a relationship between the mentioned signs and the character of JRA lesions is established. A high informativeness of the echographic method especially in the diagnosis of secondary amylosis is confirmed.

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The authors describe the results of prospective multicenter Soviet-American placebo-controlled 6-month investigations concerned with assessment of the therapeutic efficacy of auranofin in juvenile rheumatoid arthritis (JRA). 231 patients with JRA were placed under observation. Auranofin was found to be slightly superior to placebo. The drug was tolerated well. It is noted that in the treatment of JRA, of importance are long (6-month) courses of non-steroidal anti-inflammatory drugs.

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