Özge DEDEOĞLU, Eyüp SARI, Saliha ŞENEL, Can Demir KARACAN

Çocukluk çağı artritlerinin etyolojik, klinik ve laboratuar verilerinin değerlendirilmesi

Amaç: Bu çalışmanın amacı üçüncü basamak olan bir sağlık kuruluşunda artrit tanısıyla takip edilen çocuk hastaların etyolojisi, tanısal yaklaşımı, klinik ve laboratuvar verilerinin değerlendirilmesidir. Hastalar ve Yöntemler: 2008 - 2013 yılları arasında, 7 ay-18 yaş arasında, hastanede yatarak tedavi gören 306 artrit tanılı çocuk çalışmaya dahil edildi. Hastaların tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Hastaların % 51,6'sı kız, % 48.4'ü erkekti. Yaş ortalaması 118 ay idi. Hastaların % 29.4'ünde simetrik, % 70.6'sında asimetrik tip artrit tespit edildi. Hastaların tanıları sırasıyla Akut Romatizmal Ateş/Poststreptokoksik reaktif artrit (ARA/PSRA) (% 39.2), Kollajen doku hastalığı (KDH) (% 29), brusella artriti (% 13.4), reaktif artrit (% 12.5), septik artrit (% 5.2) ve maligniteye bağlı artrit (% 0.7) idi. Kollajen doku hastalığı grubunda jüvenil idyopatik artrit (JİA) en sık görülen hastalık idi (% 66.3). Patellar eklem tutulumu en sık tutulan eklemdi (% 62.4). ARA / PSRA grubu olan hastalarda ortalama ASO düzeyleri yüksek bulundu [p = 0.000]. ARA / PSRA grubunun ortalama lökosit sayısı, KDH grubundan yüksekti [p = 0.000]. ARA / PSRA grubunda ortalama nötrofil yüzdesi brusella artriti grubundan daha yüksekti [p = 0.000]. KDH hastalarında ortalama tanı ve tedavi süresi daha uzun bulundu [p = 0.000]. Brusella artriti tanılı bir hasta hariç tüm hastalar sekelsiz iyileşti. Sonuç: Artrit çocukluk çağında sistemik hastalık sürecinin bir bulgusu olabilir. Bu nedenle klinisyenin ayırıcı tanı listesi geniş olmalıdır. Kapsamlı öykü ve fizik muayeneye ek olarak seçilecek uygun laboratuvar testleriyle birlikte klinik izlem çocukluk çağında artrit nedenlerini aydınlatmaya yardımcı olabilir.

Anahtar Kelimeler:

artritler, çocukluk çağı, etyoloji

Evaluation of etiology, clinical and laboratory data of childhood arthritis

Aim: The aim of the present study was to evaluate the etiologies, diagnostic approach, clinical and laboratory data of patients with arthritis in a Turkish tertiary care hospital in children.Patients and Methods: 306 hospitalized children aged between 7 months-18 years, diagnosed with arthritis were included in the study between 2008 – 2013. The medical records of patients were reviewed retrospectively.Results: Of the patients, 51.6% were female, 48.4% were male. The average age was 118 months. Arthritis was symmetrical type in 29.4% of patients and asymmetrical type in 70.6%. The diagnoses of patients were Acute Rheumatic Fever/Poststreptococcal reactive arthritis (ARF/PSRA) (39.2%), Collagen Tissue Disorders (CTD) (29%), Brucellar arthritis (13.4%), reactive arthritis (12.5%), septic arthritis (5.2%) and arthritis secondary to malignancy (0.7%), respectively. Of the patients with CTD; Juvenil idiopathic arthritis (JIA) was the most common in frequency (66.3%). Patellar joint involvement was the most common in frequency (62.4%). The mean ASO levels was significantly higher in patients with ARF/PSRA group [p=0.000]. Average leucocyte count of ARF/PSRA group was significantly higher than CTD group [p=0.000]. Average neutrophil percentage was significantly higher in ARF/PSRA group than brucellar arthritis group [p=0.000]. The mean duration of diagnosis and therapy was found to be significantly longer in patients with CTD [p=0.000]. All patients were cured except one patient with brucellar arthritis. Conclusion: Arthritis can be a manifestation of multiple disease processes in children. Therefore, the clinician must consider a broad differential diagnosis. Detail history and physical examination with a clinical follow-up in addition to useful laboratory testing may help to establish the cause of arthritis in children.

Keywords:

arthritis, children, etiology,

PDF

___

1. Tan A, Strauss VY, Protheroe J, Dunn KM. Epidemiology of paediatric presentations with musculoskeletal problems in primary care. BMC Musculoskelet Disord 2018; 19:40.
2. Kimura Y, Southwood TR. Evaluation of the child with joint pain and/or swelling. https://www.uptodate.com. 2018.
3. Cavkaytar O, Düzova A, Tekşam O and et al. Final diagnosis of children and adolescents with musculoskeletal complaints. Minerva Pediatr 2017; 69:50-58.
4. Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev 2014; 13: 546-49.
5.Yang YH, Yu HH, Chiang BL. The diagnosis and classification of Henoch-Schönlein purpura: an updated review. Autoimmun Rev 2014; 13: 355-58.
6. Pilkington C, Tjärnlund A, Bottai M and et al; members of the IMCCP International Myositis Classification Criteria Project. Progress report on the development of new classification criteria for adult and juvenile idiopathic inflammatory myopathies. Arthritis Rheumatol 2014; 66: 70.
7.Burke RJ, Chang C. Diagnostic criteria of acute rheumatic fever. Autoimmun Rev 2014; 13: 503-7.
8. Stephenson JL, Shipman AR. The Systemic Lupus International Collaborating Clinics criteria have replaced the American College of Rheumatology guidelines for the diagnosis of systemic lupus erythematosus. Clin Exp Dermatol 2014; 39: 431-32.
9. Riise QR, Handeland KS, Cvancarova M and et al. Incidence and Characteristics of Arthritis in Norwegian Children: A Population-Based Study Pediatrics 2008; 121: 299-306.
10. Cattalini M, Soliani M, Caparello MC and et al. Sex differences in Pediatric Rheumatology. Clin Rev Allergy Immunol 2017.
11. Narin N, Mutlu F, Argun M and et al. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011. Cardiol Young. 2015; 25: 745-51.
12. Boyarchuk O, Boytsanyuk S, Hariyan T. Acute rheumatic fever: clinical profile in children in western Ukraine. J Med Life 2017; 10: 122-26.
13. Sato S, Uejima Y, Suganuma E and et al. A retrospective study: Acute rheumatic fever and post-streptococcal reactive arthritis in Japan. Allergol Int 2017; 66: 617-20.
14. Olaosebikan BH, Adelowo OO, Animashaun BA and et al. Spectrum of paediatric rheumatic diseases in Nigeria. Pediatr Rheumatol Online J 2017; 15:7.
15. Aksu K, Dokuyucu O, Ertenli AI and et al. Cost of Familial Mediterranean Fever [FMF] Disease In Turkey. Value Health 2015; 18: 666.
16. Parlak M, Akbayram S, Doğan M and et al. Clinical manifestations and laboratory findings of 496 children with brucellosis in Van, Turkey. Pediatr Int 2015; 57: 586-89.
17. Bosilkovski M, Kirova-Urosevic V, Cekovska Z and et al. Osteoarticular involvement in childhood brucellosis: experience with 133 cases in an endemic region. Pediatr Infect Dis J 2013; 32 :815-19.
18. Yu DT, Van Tubergen A. Reactive arthritis 2018.
19. Di Loreto S, Fabiano C, Nigro G. High prevalence of streptococcal or Epstein-Barr virus infections in children with acute non-septic monoarthritis. New Microbiol 2014; 37:81-86.