(1)Department of Rheumatology, Princess Margaret
Hospital for Children, GPO Box D184, Perth, WA 6014, Australia
Abstract
Abstract The Durban classification system
for juvenile idiopathic arthritis (JIA) is reviewed in a historical
context and in association with a review of problems that have
become apparent. These include: (i) a family history of psoriasis
as an exclusion factor (oligoarthritis and enthesitis-related arthritis)
and as in inclusive factor (psoriatic arthritis); (ii) a family
history of HLA-B27-associated disease as an exclusion factor (oligoarthritis)
and an inclusive factor (enthesitis-related arthritis); (iii) the
requirement of a dermatological opinion for psoriasis; (iv) the
absence of HLA-B27 antigen in proband, with the presence of antigen
in the family history; (v) the definition of time of onset; (vi)
the presence of rheumatoid factor (RF) with oligoarthritis; (vii)
HLA-B27-positive males with an onset of arthritis after 8 years
of age. Modifications are suggested to maintain the homogeneity
of groupings for research, whilst providing a practical scheme
for clinicians. Three main modifications are suggested. (A) That
the family history be included in descriptors rather than as inclusive
or exclusion criteria. (B) Further development of the hierarchical
system, which is partly used in the Durban classification. (C)
That the following changes be made: rheumatoid-factor-positive
oligoarthritis and polyarthritis be classified together; extended
oligoarthritis and polyarthritis be classified together; HLA-B27-positive
disease be classified with fewer inclusive and exclusion criteria;
the criteria for psoriatic arthritis be modified; the classification
of the disease in a particular child be changed in the event of
relevant changes in the child's disease or laboratory profile.
These suggestions are made to stimulate discussion.
