Juvenil romatoid artrit (JRA)’te kalp kapakçık tutulumu nadir bir komplikasyondur. Sistemik başlangıçlı ve seropozitiflik gösteren hastalarda en sık olarak aort. kullanılan jüvenil kronik artrit veya jüvenil romatoid art- rit yerine uyarlanmıştır. En yaygın görülen, kısa ve uzun dönemli birçok engelliliğe yol açabilen, çocukluk. Hasta 15 yıldır juvenil romatoid artrit tanısı izlenmekte ve o zamandan beri salicylazosulfapyridine 2×2 g ve 30 mg prednisolon kullanmaktaydı. Hastanın boyu.
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Ekokardiografi, juvenil romatoid artrit, kapak tutulumu. There are only a few cases reported with mitral involvement always associated with pericarditis.
As cardiac involvement can occur at any time regardless of the severity and the type of the disease, regular cardiac examination should be performed to patients with JRA.
Echocardiography, juvenile juvehil arthritis, valvular involvement. Juvenile rheumatoid arthritis JRA is a group of diseases characterized by chronic synovitis and associated with a number of extra-articular inflammatory manifestations 1.
Valvular heart disease due to JRA diagnosed during life romatold rare and usually is seen in the systemic pattern or in seropositive patients with severe destructive articular disease. Involvement of the mitral valve in seronegative, polyarticular JRA is rare. A 9-year-old boy was admitted to our hospital for evaluation and treatment of pain and limited movements of the neck.
Nine months before the current admission, he had had a macular rash that lasted for three days. For the last two months, his neck had become painful and finally the movements were restricted especially in extension, though he had been using salicylates. On admission he was afebrile His height and weight were on the 25 percentile for his age. The neck was stiff and painful especially in extension.
Juvenil kronik artrit – Vikipedi
There were no deformities in the joints. No skin rash, lymphadenopathy, hepatosplenomegaly or subcutaneous nodules were detected. The ophthalmic examination showed no abnormalities. The electrocardiogram showed normal sinus rhythm and PR interval. Chest radiograph revealed out normal lung structure and cardiac silhouette.
The x-ray examination of the romaotid joints and spine did not reveal the changes of ankylosing spondilitis.
Antero-posteior spine bone densitometry showed osteoporosis compared to his age group. Echocardiography was carried out using a Hewlett-Packard Sonos echocardiogram with 3.
Findings were as follows: Left ventricular end-diastolic dimension: Ejection fraction and fractional shortening were Pericardial effusion was not detected. Laboratory examination showed urine to be normal. The hemoglobin was 1. Juenil white blood cell count was The serum total protein, albumin, electrolytes, calcium, phosphorus, glucose and the other renal and liver function tests were normal.
Tests for serum rheumatoid factor, antinuclear antibodies and anti-DNA were negative.
Blood and urine cultures yielded a negative result and a throat swab showed normal flora. At the end of the third week his neck movements improved significantly. Though pericarditis is the most common cardiac manifestation of JRA, myocardial, endocardial and valvular involvement also have been reported The valvular heart disease which is rarely diagnosed during life is due to both specific granulamatous nodules and nonspecific lesions which are histologically described.
Usually the aortic valve is affected 6. There are some reports about aortic valve replacement during the follow-up of JRA The reported cases with mitral regurgitation are rare. Though Brewer 9 and Walsh 10 described two and three cases with mitral insufficiency respectively, the clinical features of JRA and cardiac lesions were not clarified. Our patient had polyarticular, seronegative JRA with no joint deformity.
His cardiac lesion was predominantly mitral regurgitation associated with mild aortic incompetence but without pericarditis which distinguishes him from previously described patients.
The differential diagnosis in our patient included rheumatic fever. Absence of antistreptococcal antibodies, long duration of polyarthritis with no response to salicylates, normal PR interval suggests rheumatoid arthritis rather than rheumatic fever.
We suggest that regular cardiac assessment should be carried out in every patient with JRA in which cardiac involvement can occur at any time regardless of the severity of the illness. Textbook of Pediatric Rheumatology. Cardiac involvement in collagen disease. Eur Heart J ; Heart defects in rheumatoid arthritis patients the results of a multiyear prospective clinico-echocardiographic study. Ter Arkh ; Dilated cardiomyopathy in juvenile chronic arthritis. Scand J Rheumatol ; Aortic regurgitation in seropositive juvenile arthritis.
Ann Rheum Dis ; Aortic incompetence in pauciarticular juvenile chronic arthritis. Arch Dis Child ; Rittoo D, Sutherland GR. Posterior left ventricular pseudoaneurysm after aortic valve replacement in a patient with rheumatoid arthritis: J Am Soc Echocardiogr ; 7: Severe aortic insufficiency in juvenile chronic arthritis.
Am J Med ; Arthritis Rheum ; Some clinical features of juvenile rheumatoid arthritis. Med J Aust ; 1: Mitral and aortic insufficiency in polyarticular juvenile rheumatoid arthritis. Pediatr Cardiol ;