Grace Cole 1

Biology 110, section DF1

Professor Mateja
October 8, 2014

Systemic Juvenile Idiopathic

Arthritis
A REVIEW

Juvenile Idiopathic Arthritis 1

Juvenile Idiopathic Arthritis 2

Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a form of juvenile idiopathic arthritis
(JIA). This subtype involves systemic features of fever, rash, inflammation, and enlargement of
liver or spleen. In the review article, Hay and Ilowite summarized the symptoms, clinical
diagnosis and prognosis, and treatment of sJIA (Hay & Ilowite, 2012). The paper also educated
readers in a syndrome called Macrophage Activation Syndrome (MAS) that is associated with
sJIA and is very fatal. The authors discussed the implications of the pathogenesis and the
treatments of each stage. They found that the overall treatment of sJIA attempts to ease systemic
features and joint inflammation whilst supporting joint function and reducing joint damage.
Sometimes comparing JIA to its subtype, the authors explained different treatment options for
the additional symptoms found in sJIA.

Juvenile Idiopathic Arthritis 3

Systemic Juvenile Idiopathic Arthritis

A review
This article has been characterized as a review by the title, though I also find it very
educational. The authors explain many clinical manifestations of systemic juvenile idiopathic
arthritis and the treatments for later developments. The central concept presented in the article is
the capricious nature of pathogenesis and the many complications of sJIA. To deliberate this
theme, the paper is split up into sections based on the different stages of the disease.
The authors purpose in writing the article is to educate readers in the clinical
presentation, different diagnoses, potential complications and current algorithm for treatment
escalation (Hay & Ilowite, 2012) of sJIA. The key ideas defined in the article are as follows:
clinical manifestations of sJIA, pathogenesis, treatment options, Macrophage Activation
Syndrome, and course and prognosis. In order to get the major points across, the authors
reiterate the thinking behind prognosis and treatments and provided illustrative diagrams for
treatment escalation for the active systemic features at every step of the article.
A strength presented by the authors were the many supporting images, sidebars, and
diagrams that reinforce the treatments they talk about. The formatting and diagrams were a
definite help in explaining and demonstrating the pathogenesis of sJIA and how each step is
treated. However, a glaring weakness of the paper is the bias toward Macrophage Activation
Syndrome. In the Educational Objectives sidebar, it states that the article will educate readers
about potential complications of systemic juvenile idiopathic arthritis (Hay & Ilowite, 2012).
An entire section of the paper is dedicated to MAS, but no other complication was discussed.
The authors recommend vigilance in respect to MAS. Prompt detection and swift treatment are
strongly suggested.

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Overall, the authors seemed balanced, although they definitely support consuming a
plethora of medicine. However, the results of treatment are discussed inadequately. For
instance, although NSAIDs can be helpful, when used alone they are rarely successful in fully
treating the systemic symptoms (Hay & Ilowite, 2012). The article then moves on to additional
measures and medicines to take. They dont fully explain the pros and cons of each treatment
they introduce; they only suggest and advise.
My perspective has changed to understand much more about pathogenesis and the
measures to be taken. This article revealed different courses of sJIA monocyclic courses with
complete recovery and polycyclic with multiple episodes of active disease followed by periods
of remission (Hay & Ilowite, 2012). I had not previously realized that diseases are so multifaceted, or that it is so hard to recognize the identity of diseases because of how much the
symptoms overlap. I also now know more about how doctors will pair treatments and medicines
together to achieve differing goals, but overall alleviate pain on the patient.
My question based on the paper is how common sJIA is in children in general. This
article left me wondering the prevalence of sJIA in children. The authors provided percentages
on systemic juvenile idiopathic arthritis in children with JIA, but not children overall. They did
not clarify how prevalent systemic juvenile idiopathic arthritis is in children, healthy or diseased.

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References
Hay, A. D., & Ilowite, N. T. (2012). Systemic juvenile idiopathic arthritis: A review. Pediatric
Annals, 41(11), 1-6. doi:http://dx.doi.org/10.3928/00904481-20121022-10