Comparison of tolmetin sodium and aspirin in the treatment of juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis. Mode of onset as key to early diagnosis and management

Juvenile rheumatoid arthritis, which affects almost a quarter of a million American children, is diagnosed at the patient's first visit to the physician in only about half of all cases. Early diagnosis rests on recognition of three distinct modes of onset and is important in preventing deformities, blindness, and even death.

Pharmacotherapy of juvenile rheumatoid arthritis

Salicylate is the drug of first choice in the initial treatment of juvenile rheumatoid arthritis. In therapeutic dosage it will adequately control joint symptoms in the majority of patients. For children who do not respond to or are intolerant of salicylate, a change to one of the other nonsteroidal anti-inflammatory agents is appropriate. In progressive polyarthritis unresponsive to the above agents, the addition of gold, antimalarials, or penicillamine is indicated, preferably in that order. Corticosteroid therapy should be reserved for selected patients meeting specific criteria. Pharmacotherapy of juvenile rheumatoid arthritis should always be individualized. For optimal treatment of the whole child it must be combined with both physical and educational measures.

Juvenile rheumatoid arthritis. A comparison of patients from the USSR and USA

Juvenile rheumatoid arthritis (JRA) in the Union of Soviet Socialist Republics (USSR) and the United States (USA) shows a remarkable similarity in age of disease onset, subtype onset, frequency, and most laboratory measurements. There is variation in the therapeutic approach with heavier reliance on aspirin in the USA. The evolution of JRA from onset subtype to final subtype over 5 years was the same in both groups and was independent of the type of therapy.