Annals of Tropical Paediatrics International Child Health
ISSN: 0272-4936 (Print) 1465-3281 (Online) Journal homepage: http://www.tandfonline.com/loi/ypch19
Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait F. A. Khuffash, H. A. Majeed, M. M. Lubani, K. N. Najdi, S. S. Gunawardana & R. Bushnaq To cite this article: F. A. Khuffash, H. A. Majeed, M. M. Lubani, K. N. Najdi, S. S. Gunawardana & R. Bushnaq (1990) Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait, Annals of Tropical Paediatrics, 10:3, 255-259, DOI: 10.1080/02724936.1990.11747439 To link to this article: http://dx.doi.org/10.1080/02724936.1990.11747439
Published online: 13 Jul 2016.
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Citing articles: 16 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypch19 Download by: [University of Saskatchewan Library]
Date: 24 August 2017, At: 13:50
Annals of Tropical Paediatrics ( 1990) 10, 255-259
Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait
Downloaded by [University of Saskatchewan Library] at 13:50 24 August 2017
F. A. KHUFFASH, H. A. MAJEED, M. M. LUBANI,* K. N. NAJDI,** S. S. GUNA WARD ANA*** & R. BUSHNAQt Departments of Paediatrics, Faculty of Medicine, Kuwait University, *Farwaniya Hospital, **Adan Hospital, ***Jahra Hospital and t Amiri Hospital, Kuwait (Received 11 December 1989)
Summary. An 8-year hospital-based retrospective study on the epidemiology of juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE) and other connective tissue diseases among children in Kuwait is described. There were 108 children with JCA, 20 children with SLE, 23 children with other connective tissue diseases and 24 children with arthritis of familial Mediterranean fever (FMF). The average annual incidence of JCA was 2.84 cases/105 children under the age of 12 years and the 1988 prevalence was 18.7/105 • The polyarticular, systemic and oligoarticular onset types were observed in 42, 29 and 29~o, respectively. The incidence and prevalence of SLE were 0.53 and 3.37/105 , respectively. The findings are compared with those from other countries.
Introduction Studies on the epidemiology of juvenile chronic arthritis (JCA) have shown wide variations in its incidence and prevalence. These variations have been attributed to the varied presentation and to the diverse clinical course of }CA, as well as to varying study methods and populations surveyed.1-3 Few studies have addressed the prevalence of systemic lupus erythematosus (SLE) and other connective tissue diseases in children, 4 and highlighted the ethnic differences in such prevalences. 4-6 This report presents information about the epidemiology of these diseases in children under the age of 12 years in the paediatric departments of five regional hospitals in Kuwait, serving over 75~ 0 of the population of the country (1985 Census). The
findings are compared with those from other countries.
Patients and methods Population surveyed The study was conducted in five regional government hospitals that serve 1.35 million people and receive referrals from all peripheral clinics and private clinics and hospitals. Itincludedallchildren undertheageofl2 years who had connective tissue disease diagnosed between January 1981 and December 1988. Olderchildrenarereferred to the adults' medical departments according to the regulations of the Ministry of Public Health. The five hospitals provide free and comprehensive medical care, hence almost all children with connective tissue diseases are referred for hospital work-up and management.
Reprint requests to: Dr Faisal A. Khuffash, Associate Professor, Department of Paediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait.
256
F. A. Khuffash et al.
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TABLE I. Incidence and prevalence of connective tissue diseases/lOO 000 children under the age of 12 years in Kuwait Diagnosis
No.
Incidence
Prevalence
Juvenile chronic arthritis Systemic lupus erythematosus Other connective tissue diseases Chronic arthritis with FMF*
108 20 23 24
2.84 0.53 0.61 0.63
18.74 3.37 2.88 4.21
Total
175
4.61
29.20
*FMF: familial Mediterranean fever.
Diagnostic criteria The diagnosis of JCA was made if there was persistent arthritis in one or more joints for at least 3 months 7 with exclusion of diseases with similar manifestations. 8 The arthritis was considered polyarticular if five or more joints were involved within 6 months of the onset. 8 ' 9 The course sub-types were decided according to the pattern of joint involvement in the systemic onset JCA9 ' 10 and according to positivity for rheumatoid factor and antinuclear antibody in the other onset types.s- 10 Systemic lupus erythematosus and other connective tissue diseases were diagnosed according to the ARA diagnostic criteria, 11 and the diagnosis of familial Mediterranean fever (FMF) was made according to Hellers' criteria. 12 Particular emphasis was laid on the exclusion of Brucella arthritis, as the disease reached epidemic proportions during the period of this study. 13 Acute rheumatic fever (ARF) has been extensively studied and reported elsewhere. 14 A senior paediatrician in each of the five hospitals obtained the medical records of all children admitted with the diagnosis of JCA, SLE, other connective tissue diseases, arthritis, synov1t1s, polyarthritis, mtls, myalgia or fever of unknown origin. Only patients who met the diagnostic criteria were included in the analysis. The exclusion of brucellosis was required in all children. The case was considered for incidence estimates if the child met the diagnostic criteria between
January 1981 to December 1988. The average annual incidence was related to the population at risk. 1 A prevalence case was defined as a child living in 1988, who previously had met the diagnostic criteria, even if currently in remission. 1' 2
Results One hundred and seventy-five children met the preset diagnostic criteria (Table I). Of 56 children with FMF, only 24 were included because they presented as chronic arthritis, simulating monoarticular J CA in 18 patients, ARF in 3, polyarticular JCA in 2 and ankylosing spondylitis in 1 patient. The diagnosis of FMF in these cases became obvious during the course of the illness as each child developed recurrent peritonitis and/or pleurisy. During the period of the study, Brucella arthritis was encountered in just over 360 children. 13 One hundred and eight children met the diagnostic criteria for JCA. The polyarticular, systemic and oligoarticular onset types were observed in 42, 29 and 29%, respectively. The basic epidemiological features of the various onset types and course subtypes are depicted in Table II. The average annual incidence of JCA was 2.84/100 000 children and the 1988 prevalence was 18.7/10000 children. The average annual incidence and the 1988 prevalence for SLE were 0.53 and 3.37/100 000 children, respectively. There were 17 girls and three boys, with a F:M ratio
Epidemiology of chronic arthritis in Kuwait
251
TABLE 11. The basic epidemiological features of juvenile chronic arthritis among children under the age of 12 years in Kuwait
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Onset type Polyarticular Polyarticular Systemic Systemic Oligoanicular Oligoarticular Oligoanicular
Subtype
Age range (yrs) (mean)
M:F ratio
(33) (9) (12) (17) (8) (18) (3)
1.5-12 (7.7) 8-12 (9.7) 1.2-9 (5.6) 1-10 (5.4) 1-8 (4.8) 1-12 (10.3) 10-11 (10.3)
1.40 1.00 2.25 0.80 0.13 0.70 0.50
108 (100)
1-12 (7.2)
0.96
No.(%)
seronegative seropositive polyanicular oligoanicular ANA positive ANA negative seropositive
Total
36 10 13 18 9 19 3
TABLE Ill. Reponed incidence and prevalence of juvenile chronic arthritis/10' children
Place (ref. no.) Rochester, USA'* Finland" Monroe County, USA'* British Columbia' 6 * Baltimore, USA"* Taplow, UK 18* Kuwait (1981-1988)**
Incidence
Prevalence
13.9 3.5
113.4 12.0 27.0
2.2 6.25 2.84
19.0 60.0 18.7
Method of case identification General population Hospitalized patients Anhritis clinics Anhritis clinics Ambulatory care clinics Anhritis clinics Hospitalized patients
*Refers to children under the age of 16 years; **refers to children under the age of 12 years.
of5.7:1. The 23 children with other connective tissue diseases were 7 with dermatomyositis, 6 with overlap syndromes, 5 with scleroderma and 5 with reactive arthritis including Reiter's syndrome. Discussion Hospital-based surveys of] CA, like the present study, usually show low incidence and prevalence figures compared with surveys carried out in the general paediatric population (Table Ill). The average annual incidence of JCA in this survey compares with that in two similarly conducted studies from Finland 15 and British Columbia, 16 but is much lower than that reported from Rochester, USA, 1 where the study was
carried out in the general paediatric population (Table Ill). Prevalence figures ranged between 12 and 113.4/105 children. 1•2 •15- 18 The highest figures for both incidence and prevalence were reported by Towner et a/. 1 and were explained by the inclusion of the mild oligoarticular onset type, which constituted 75% of their JCA cases. Milder cases may not be referred to hospitals or rheumatology clinics. 1- 3 This may explain the relative under-representation of oligoarticular JCA in this study, as well as in our previous study, 19 although a true difference in the relative frequency of various onset types cannot be excluded. It is noteworthy that the upper age limit of 12 years in our children is lower than that in other surveys 1' 2 ' 18 and this might have affected the relative frequency of the
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F. A. Khuffash et al.
polyarticular seropositive chronic arthritis. Furthermore, we could not observe the well documented female preponderance, 1' 2' 7 except in the oligoarticular onset type, particularly the ANA positive subtype (Table 11). Ethnic differences in the epidemiology of JCA have been reported. Hill found the disease to be three times commoner in Indians than in whites living in British Columbia. 16 Whether the variations in the relative frequency of various onset types and the lack of female dominance in this study can be explained on the basis of ethnic difference is not clear. HLA-DR typing in our patients is in the stage of planning. However, a study in adults' rheumatoid arthritis has shown an increased frequency ofDR4 (40% compared with 21.4°~ in controls). 20 Accurate figures on the epidemiology of SLE in children are difficult to obtain. Figures from this survey compare with those reported from Baltimore5 and Rochester, 6 as well as with general incidence figures from the United States. 21 Though reportedly rare in children, SLE constituted about 10% of the rheumatological disorders seen in our hospitals and is probably as common as all other connective tissue disorders excluding JCA (Table I). The majority of children with FMF arthritis presented with monoarticular arthritis which lasted from 6 weeks to 3 years. 22 Diagnostic difficulties with septic arthritis at the onset and with oligoarticular JCA in due course were inevitable. Presentation with polyarticular arthritis was confused with ARF and with polyarticular J CA. In addition to the development of painful serositis, the presence of the erysipelas-like lesions and positive family history proved to be reliable diagnostic indicators. 22 Connective tissue diseases among children in this area appear to be as common as they are in developed countries. The clinical profile of JCA is also essentially similar. Physicians in this area should be particularly aware of two conditions that may mimic JCA, namely, Brucella arthritis and arthritis of familial Mediterranean fever.
References
2
3 4
5
6
7
8
9 10
11
12 13 14
15
16 17
18
Towner SR, Michet Jr CJ, O'Fallon WM, Nelson AM. The epidemiology of juvenile arthritis in Rochester, Minnesota 1960-1979. Arthritis Rheum 1983; 26:1208-13. Gewanter HL, Roghmann KJ, Baum J. The prevalence of juvenile arthritis. Arthritis Rheum 1983; 26: 599-603. Silman AJ. Musculo-skeletal disorders in childhood. Br Med J 1986; 42:196--9. Michet Jr CJ, McKenna CH, Elveback LR, Kaslow RA, Kurland LT. Epidemiology of systemic lupus erythematous and other connective tissue diseases in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc 1985; 60:105-13. Hochberg MC. The incidence of systemic lupus erythematosis in Baltimore, Maryland 1970-1977. Arthritis Rheum 1985; 28:80-6. Hart HH, Grigor RR, Caughy DE. Ethnic differences in the prevalence of systemic lupus erythematosus. Ann Rheum Dis 1983; 42:529-32. Kvein TK, Hoyeraal HM, Sandstad B. Assessment methods of disease activity in juvenile rheumatoid arthritis-evaluated in a Prednisone/placebo double blind study. J Rheumatol1982; 9:696--702. Brewer Jr EJ, Bass J, Baum J, et al. Current proposed revision of JRA criteria. Arthritis Rheum 1977; 20 (suppl):195-9. Ansell B. Juvenile arthritis. Practitioner 1986; 230: 343-50. Cassidy JT, Levinson JE, Bass JC, et al. A study of classification criteria for the diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum 1986; 29:274-81. Rodnan GP, Schumacher HR, Zfaifier NJ, eds. Primer on the Rheumatic Diseases, 8th edn. Atlanta: Arthritis Foundation, 1983; 49-80,211-12. Helier H, Sohar E, SherfL. Familial Mediterranean fever. Arch Intern Med 1958; 102:50-6. Lubani M, Sharda D, Helin I. Brucella arthritis in children. Infection 1986; 14:233-6. Majeed HA, Khan N, Dabbagh M, et al. Acute rheumatic fever during childhood in Kuwait: the mild nature of the initial attack. Ann Trop Paediatr 1981; 1:13-20. Laaksonen AL. A prognostic study of juvenile rheumatoid arthritis. Acta Paediatr Scand 1966; 166: S1-163. Hill R. Juvenile arthritis in different racial groups in British Columbia. Arthritis Rheum 1977; 20:162-4. Hochberg MC, Linet MS, Voss RN, Sills EM. The occurrence of juvenile chronic arthritis in an urban black population. Arthritis Rheum 1982; 25 (Suppl): S15l. Bywater EGL. Diagnostic criteria for Still's disease. In: Bennett PM, Wood PM, eds. Population Studies of the Rheumatic Diseases. New York: Excerpta Medica Foundation, 1968; 235-40.
Epidemiology of chronic arthritis in Kuwait
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19 Khuffash FA, Majeed HA. Juvenile rheumatoid arthritis among Arab children. Scand J Rheumatol 1988; 17:292-5. 20 Bahr GM, Rook GA W, Al-Saffar M, van Embden J, Standord JL, Behbehani K. Antibody levels to mycobacteria in relation to HLA type: evidence for non-HLA-linked high levels of antibody to the
259
65 KD heat shock protein of M. bovis in rheumatoid arthritis. Clin Exp Immunol1988; 74:211-5. 21 Fessel WJ. Systemic lupus erythematosus in the community. Arch Intern Med 1974; 134:1027-32. 22 Majeed HA, Barakat M. Familial Mediterranean fever (recurrent hereditary polyserositis) in children: analysis of88 cases. Eur J Pediatr 1989; 148:636-41.
ISSN: 0272-4936 (Print) 1465-3281 (Online) Journal homepage: http://www.tandfonline.com/loi/ypch19
Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait F. A. Khuffash, H. A. Majeed, M. M. Lubani, K. N. Najdi, S. S. Gunawardana & R. Bushnaq To cite this article: F. A. Khuffash, H. A. Majeed, M. M. Lubani, K. N. Najdi, S. S. Gunawardana & R. Bushnaq (1990) Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait, Annals of Tropical Paediatrics, 10:3, 255-259, DOI: 10.1080/02724936.1990.11747439 To link to this article: http://dx.doi.org/10.1080/02724936.1990.11747439
Published online: 13 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 16 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ypch19 Download by: [University of Saskatchewan Library]
Date: 24 August 2017, At: 13:50
Annals of Tropical Paediatrics ( 1990) 10, 255-259
Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait
Downloaded by [University of Saskatchewan Library] at 13:50 24 August 2017
F. A. KHUFFASH, H. A. MAJEED, M. M. LUBANI,* K. N. NAJDI,** S. S. GUNA WARD ANA*** & R. BUSHNAQt Departments of Paediatrics, Faculty of Medicine, Kuwait University, *Farwaniya Hospital, **Adan Hospital, ***Jahra Hospital and t Amiri Hospital, Kuwait (Received 11 December 1989)
Summary. An 8-year hospital-based retrospective study on the epidemiology of juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE) and other connective tissue diseases among children in Kuwait is described. There were 108 children with JCA, 20 children with SLE, 23 children with other connective tissue diseases and 24 children with arthritis of familial Mediterranean fever (FMF). The average annual incidence of JCA was 2.84 cases/105 children under the age of 12 years and the 1988 prevalence was 18.7/105 • The polyarticular, systemic and oligoarticular onset types were observed in 42, 29 and 29~o, respectively. The incidence and prevalence of SLE were 0.53 and 3.37/105 , respectively. The findings are compared with those from other countries.
Introduction Studies on the epidemiology of juvenile chronic arthritis (JCA) have shown wide variations in its incidence and prevalence. These variations have been attributed to the varied presentation and to the diverse clinical course of }CA, as well as to varying study methods and populations surveyed.1-3 Few studies have addressed the prevalence of systemic lupus erythematosus (SLE) and other connective tissue diseases in children, 4 and highlighted the ethnic differences in such prevalences. 4-6 This report presents information about the epidemiology of these diseases in children under the age of 12 years in the paediatric departments of five regional hospitals in Kuwait, serving over 75~ 0 of the population of the country (1985 Census). The
findings are compared with those from other countries.
Patients and methods Population surveyed The study was conducted in five regional government hospitals that serve 1.35 million people and receive referrals from all peripheral clinics and private clinics and hospitals. Itincludedallchildren undertheageofl2 years who had connective tissue disease diagnosed between January 1981 and December 1988. Olderchildrenarereferred to the adults' medical departments according to the regulations of the Ministry of Public Health. The five hospitals provide free and comprehensive medical care, hence almost all children with connective tissue diseases are referred for hospital work-up and management.
Reprint requests to: Dr Faisal A. Khuffash, Associate Professor, Department of Paediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait.
256
F. A. Khuffash et al.
Downloaded by [University of Saskatchewan Library] at 13:50 24 August 2017
TABLE I. Incidence and prevalence of connective tissue diseases/lOO 000 children under the age of 12 years in Kuwait Diagnosis
No.
Incidence
Prevalence
Juvenile chronic arthritis Systemic lupus erythematosus Other connective tissue diseases Chronic arthritis with FMF*
108 20 23 24
2.84 0.53 0.61 0.63
18.74 3.37 2.88 4.21
Total
175
4.61
29.20
*FMF: familial Mediterranean fever.
Diagnostic criteria The diagnosis of JCA was made if there was persistent arthritis in one or more joints for at least 3 months 7 with exclusion of diseases with similar manifestations. 8 The arthritis was considered polyarticular if five or more joints were involved within 6 months of the onset. 8 ' 9 The course sub-types were decided according to the pattern of joint involvement in the systemic onset JCA9 ' 10 and according to positivity for rheumatoid factor and antinuclear antibody in the other onset types.s- 10 Systemic lupus erythematosus and other connective tissue diseases were diagnosed according to the ARA diagnostic criteria, 11 and the diagnosis of familial Mediterranean fever (FMF) was made according to Hellers' criteria. 12 Particular emphasis was laid on the exclusion of Brucella arthritis, as the disease reached epidemic proportions during the period of this study. 13 Acute rheumatic fever (ARF) has been extensively studied and reported elsewhere. 14 A senior paediatrician in each of the five hospitals obtained the medical records of all children admitted with the diagnosis of JCA, SLE, other connective tissue diseases, arthritis, synov1t1s, polyarthritis, mtls, myalgia or fever of unknown origin. Only patients who met the diagnostic criteria were included in the analysis. The exclusion of brucellosis was required in all children. The case was considered for incidence estimates if the child met the diagnostic criteria between
January 1981 to December 1988. The average annual incidence was related to the population at risk. 1 A prevalence case was defined as a child living in 1988, who previously had met the diagnostic criteria, even if currently in remission. 1' 2
Results One hundred and seventy-five children met the preset diagnostic criteria (Table I). Of 56 children with FMF, only 24 were included because they presented as chronic arthritis, simulating monoarticular J CA in 18 patients, ARF in 3, polyarticular JCA in 2 and ankylosing spondylitis in 1 patient. The diagnosis of FMF in these cases became obvious during the course of the illness as each child developed recurrent peritonitis and/or pleurisy. During the period of the study, Brucella arthritis was encountered in just over 360 children. 13 One hundred and eight children met the diagnostic criteria for JCA. The polyarticular, systemic and oligoarticular onset types were observed in 42, 29 and 29%, respectively. The basic epidemiological features of the various onset types and course subtypes are depicted in Table II. The average annual incidence of JCA was 2.84/100 000 children and the 1988 prevalence was 18.7/10000 children. The average annual incidence and the 1988 prevalence for SLE were 0.53 and 3.37/100 000 children, respectively. There were 17 girls and three boys, with a F:M ratio
Epidemiology of chronic arthritis in Kuwait
251
TABLE 11. The basic epidemiological features of juvenile chronic arthritis among children under the age of 12 years in Kuwait
Downloaded by [University of Saskatchewan Library] at 13:50 24 August 2017
Onset type Polyarticular Polyarticular Systemic Systemic Oligoanicular Oligoarticular Oligoanicular
Subtype
Age range (yrs) (mean)
M:F ratio
(33) (9) (12) (17) (8) (18) (3)
1.5-12 (7.7) 8-12 (9.7) 1.2-9 (5.6) 1-10 (5.4) 1-8 (4.8) 1-12 (10.3) 10-11 (10.3)
1.40 1.00 2.25 0.80 0.13 0.70 0.50
108 (100)
1-12 (7.2)
0.96
No.(%)
seronegative seropositive polyanicular oligoanicular ANA positive ANA negative seropositive
Total
36 10 13 18 9 19 3
TABLE Ill. Reponed incidence and prevalence of juvenile chronic arthritis/10' children
Place (ref. no.) Rochester, USA'* Finland" Monroe County, USA'* British Columbia' 6 * Baltimore, USA"* Taplow, UK 18* Kuwait (1981-1988)**
Incidence
Prevalence
13.9 3.5
113.4 12.0 27.0
2.2 6.25 2.84
19.0 60.0 18.7
Method of case identification General population Hospitalized patients Anhritis clinics Anhritis clinics Ambulatory care clinics Anhritis clinics Hospitalized patients
*Refers to children under the age of 16 years; **refers to children under the age of 12 years.
of5.7:1. The 23 children with other connective tissue diseases were 7 with dermatomyositis, 6 with overlap syndromes, 5 with scleroderma and 5 with reactive arthritis including Reiter's syndrome. Discussion Hospital-based surveys of] CA, like the present study, usually show low incidence and prevalence figures compared with surveys carried out in the general paediatric population (Table Ill). The average annual incidence of JCA in this survey compares with that in two similarly conducted studies from Finland 15 and British Columbia, 16 but is much lower than that reported from Rochester, USA, 1 where the study was
carried out in the general paediatric population (Table Ill). Prevalence figures ranged between 12 and 113.4/105 children. 1•2 •15- 18 The highest figures for both incidence and prevalence were reported by Towner et a/. 1 and were explained by the inclusion of the mild oligoarticular onset type, which constituted 75% of their JCA cases. Milder cases may not be referred to hospitals or rheumatology clinics. 1- 3 This may explain the relative under-representation of oligoarticular JCA in this study, as well as in our previous study, 19 although a true difference in the relative frequency of various onset types cannot be excluded. It is noteworthy that the upper age limit of 12 years in our children is lower than that in other surveys 1' 2 ' 18 and this might have affected the relative frequency of the
Downloaded by [University of Saskatchewan Library] at 13:50 24 August 2017
258
F. A. Khuffash et al.
polyarticular seropositive chronic arthritis. Furthermore, we could not observe the well documented female preponderance, 1' 2' 7 except in the oligoarticular onset type, particularly the ANA positive subtype (Table 11). Ethnic differences in the epidemiology of JCA have been reported. Hill found the disease to be three times commoner in Indians than in whites living in British Columbia. 16 Whether the variations in the relative frequency of various onset types and the lack of female dominance in this study can be explained on the basis of ethnic difference is not clear. HLA-DR typing in our patients is in the stage of planning. However, a study in adults' rheumatoid arthritis has shown an increased frequency ofDR4 (40% compared with 21.4°~ in controls). 20 Accurate figures on the epidemiology of SLE in children are difficult to obtain. Figures from this survey compare with those reported from Baltimore5 and Rochester, 6 as well as with general incidence figures from the United States. 21 Though reportedly rare in children, SLE constituted about 10% of the rheumatological disorders seen in our hospitals and is probably as common as all other connective tissue disorders excluding JCA (Table I). The majority of children with FMF arthritis presented with monoarticular arthritis which lasted from 6 weeks to 3 years. 22 Diagnostic difficulties with septic arthritis at the onset and with oligoarticular JCA in due course were inevitable. Presentation with polyarticular arthritis was confused with ARF and with polyarticular J CA. In addition to the development of painful serositis, the presence of the erysipelas-like lesions and positive family history proved to be reliable diagnostic indicators. 22 Connective tissue diseases among children in this area appear to be as common as they are in developed countries. The clinical profile of JCA is also essentially similar. Physicians in this area should be particularly aware of two conditions that may mimic JCA, namely, Brucella arthritis and arthritis of familial Mediterranean fever.
References
2
3 4
5
6
7
8
9 10
11
12 13 14
15
16 17
18
Towner SR, Michet Jr CJ, O'Fallon WM, Nelson AM. The epidemiology of juvenile arthritis in Rochester, Minnesota 1960-1979. Arthritis Rheum 1983; 26:1208-13. Gewanter HL, Roghmann KJ, Baum J. The prevalence of juvenile arthritis. Arthritis Rheum 1983; 26: 599-603. Silman AJ. Musculo-skeletal disorders in childhood. Br Med J 1986; 42:196--9. Michet Jr CJ, McKenna CH, Elveback LR, Kaslow RA, Kurland LT. Epidemiology of systemic lupus erythematous and other connective tissue diseases in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc 1985; 60:105-13. Hochberg MC. The incidence of systemic lupus erythematosis in Baltimore, Maryland 1970-1977. Arthritis Rheum 1985; 28:80-6. Hart HH, Grigor RR, Caughy DE. Ethnic differences in the prevalence of systemic lupus erythematosus. Ann Rheum Dis 1983; 42:529-32. Kvein TK, Hoyeraal HM, Sandstad B. Assessment methods of disease activity in juvenile rheumatoid arthritis-evaluated in a Prednisone/placebo double blind study. J Rheumatol1982; 9:696--702. Brewer Jr EJ, Bass J, Baum J, et al. Current proposed revision of JRA criteria. Arthritis Rheum 1977; 20 (suppl):195-9. Ansell B. Juvenile arthritis. Practitioner 1986; 230: 343-50. Cassidy JT, Levinson JE, Bass JC, et al. A study of classification criteria for the diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum 1986; 29:274-81. Rodnan GP, Schumacher HR, Zfaifier NJ, eds. Primer on the Rheumatic Diseases, 8th edn. Atlanta: Arthritis Foundation, 1983; 49-80,211-12. Helier H, Sohar E, SherfL. Familial Mediterranean fever. Arch Intern Med 1958; 102:50-6. Lubani M, Sharda D, Helin I. Brucella arthritis in children. Infection 1986; 14:233-6. Majeed HA, Khan N, Dabbagh M, et al. Acute rheumatic fever during childhood in Kuwait: the mild nature of the initial attack. Ann Trop Paediatr 1981; 1:13-20. Laaksonen AL. A prognostic study of juvenile rheumatoid arthritis. Acta Paediatr Scand 1966; 166: S1-163. Hill R. Juvenile arthritis in different racial groups in British Columbia. Arthritis Rheum 1977; 20:162-4. Hochberg MC, Linet MS, Voss RN, Sills EM. The occurrence of juvenile chronic arthritis in an urban black population. Arthritis Rheum 1982; 25 (Suppl): S15l. Bywater EGL. Diagnostic criteria for Still's disease. In: Bennett PM, Wood PM, eds. Population Studies of the Rheumatic Diseases. New York: Excerpta Medica Foundation, 1968; 235-40.
Epidemiology of chronic arthritis in Kuwait
Downloaded by [University of Saskatchewan Library] at 13:50 24 August 2017
19 Khuffash FA, Majeed HA. Juvenile rheumatoid arthritis among Arab children. Scand J Rheumatol 1988; 17:292-5. 20 Bahr GM, Rook GA W, Al-Saffar M, van Embden J, Standord JL, Behbehani K. Antibody levels to mycobacteria in relation to HLA type: evidence for non-HLA-linked high levels of antibody to the
259
65 KD heat shock protein of M. bovis in rheumatoid arthritis. Clin Exp Immunol1988; 74:211-5. 21 Fessel WJ. Systemic lupus erythematosus in the community. Arch Intern Med 1974; 134:1027-32. 22 Majeed HA, Barakat M. Familial Mediterranean fever (recurrent hereditary polyserositis) in children: analysis of88 cases. Eur J Pediatr 1989; 148:636-41.
