Diagnosis and classification of juvenile idiopathic arthritis
Diagnosis and classification of juvenile idiopathic arthritis
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DOI：
10.1016/j.jaut.2014.01.009
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发表时间：
2014-02-01
影响因子：
12.8
通讯作者：
Berkun, Yackov
中科院分区：
文献类型：
--
作者：
Eisenstein, Eli M.;Berkun, Yackov
近年来，人们越来越清楚地认识到，幼年特发性关节炎（JIA）一词不仅包括一种疾病，还包括几种疾病。此外，最近的研究强烈表明，其中一些临床病理生理实体似乎跨越了当前的诊断类别。JIA分类的最终目的是通过提高对病理生理学的理解，促进对不同形式疾病的更好、更具体的治疗。在过去的二十年中，许多患有慢性关节炎的儿童在治疗和改善预后方面取得了重大进展。然而，对这些疾病背后的基本生物学过程的理解仍远未完成。因此，即使是当今最好的生物制剂也只是“半途而废的技术”。因为它们不治疗基本的生物过程，它们本身就很昂贵，需要长时间给予以改善慢性炎症的不良影响，并且不能治愈疾病。儿科风湿病学现在正进入一个诊断类别可能需要改变以跟上发现的时代。一个更精确的，基于生物学的分类可能有助于开发更具体和改进的治疗各种形式的儿童关节炎的方法。在这篇综述中，我们讨论了遗传、基因表达和免疫学发现如何开始影响这些疾病的理解和分类。(C) 2014年Elsevier Ltd.出版
In recent years, it has become increasingly clear that the term Juvenile Idiopathic Arthritis (JIA) comprises not one disease but several. Moreover, recent studies strongly suggest that some of these clinico-pathophysioloigic entities appear to cross current diagnostic categories. The ultimate goal of the JIA classification is to facilitate development of better, more specific therapy for different forms of disease though improved understanding of pathophysiology. The past two decades have witnessed significant advances in treatment and improved outcomes for many children with chronic arthritis. However, understanding of the basic biologic processes underlying these diseases remains far from complete. As a result, even the best biologic agents of today represent "halfway technologies". Because they do not treat fundamental biologic processes, they are inherently expensive, need to be given for a long time in order to ameliorate the adverse effects of chronic inflammation, and do not cure the disease. Pediatric rheumatology is now entering an era in which diagnostic categories may need to change to keep up with discovery. A more precise, biologically based classification is likely to contribute to development of more specific and improved treatments for the various forms of childhood arthritis. In this review, we discuss how genetic, gene expression, and immunologic findings have begun to influence how these diseases are understood and classified. (C) 2014 Published by Elsevier Ltd.