Operations in Juvenile Rheumatic Diseases Rheumatoid Arthritis in Childhood - Operative Therapy

Juvenile rheumatoid arthritis is a multifaceted disease. Nonsteroidal anti-inflammatory drugs are the standard first line of therapy. Second-line therapy of disease modifying anti-rheumatic 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 [1]. Operative therapy in rheumatoid arthritis in childhood in youth centers in mono-and pauci-articular course of disease. Mostly they are so-called non responders, children or juveniles who do show incomplete or no restitution of their pathological findings when treated with antirheumatic drugs. On the contrary to adult rheumatoid arthritis therapy operative treatment rather stands at the end of the treatment range, this appears in the actual S2-guidelines of the JIA [2]. Indications for operative therapy however are also polyarticular forms with a tendency towards deterioration of deformity in already destroyed parts of joints of the loco motor system. Substantial discrepancy between clinical symptoms and subjective statements of pain by children and young adults needs close control in order to lead relevant findings towards operative treatment in time. Basically joint and soft tissue retaining procedures are differentiated from joint replacing procedures. The aim is to positively influence the course of destruction and so to stop the destructive power of the disease or at least reduce it.