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J Am Acad Orthop Surg, Vol 13, No 4, July/August 2005, 254-266.
© 2005 the American Academy of Orthopaedic Surgeons
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Management of the Upper Extremity in Juvenile Rheumatoid Arthritis

Dane Glueck, MD and Harris Gellman, MD

Dr. Glueck is Orthopaedic Resident, Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY. Dr. Gellman is Voluntary Clinical Professor, Department of Orthopaedic Surgery, University of Miami, FL, and University of Arkansas, Little Rock, AR.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Glueck and Dr. Gellman.

Reprint requests: Dr. Gellman, Broward Hand Center, Suite 305, 3100 Coral Hills Drive, Coral Springs, FL 33065-4137.

Juvenile rheumatoid arthritis is a multifaceted disease. Average age of onset is 6 years, with peaks between 1 and 4 and between 9 and 14 years. Girls are affected more frequently than boys. Nonsteroidal anti-inflammatory drugs are the standard first line of therapy. Second-line therapy of antirheumatic drugs may be used early for progressive disease. Intra-articular corticosteroid injections should be considered to preserve joint mobility and muscle strength when medical treatment fails to control synovitis or when marked functional impairment exists. Historically, surgery has been a last resort, but in appropriate patients, it should be considered soon after failure of conservative management. However, when possible, reconstructive surgery should be delayed until completion of skeletal growth.






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Copyright © 2005 by the American Academy of Orthopaedic Surgeons.