Nguyên nhân, đặc điểm dịch tễ học lâm sàng bệnh khớp ở trẻ em

B GIO DC V O TO B Y T TRNG I HC Y H NI NGUYN TH PHNG THO NGUYÊN NHÂN, ĐặC ĐIểM DịCH Tễ HọC LÂM SàNG BệNH KHớP TRẻ EM LUậN VĂNTốT NGHIệP BáC Sĩ NộI TRú H NI - 2015 B GIO DC V O TO B Y T TRNG I HC Y H NI NGUYN TH PHNG THO NGUYÊN NHÂN, ĐặC ĐIểM DịCH Tễ HọC LÂM SàNG BệNH KHớP TRẻ EM Chuyờn ngnh : Nhi khoa Mó s : NT 62721655 LUậN VĂNBáC Sĩ NộI TRú Ngi hng dn khoa hc: PGS.TS Nguyn Th Diu Thỳy H NI - 2015 LI CM N hon thnh lun ny, tụi ó nhn c s giỳp tn tỡnh ca nh trng, thy cụ giỏo v bnh vin Tụi xin trõn trng gi li cm n ti: Ban Giỏm hiu trng i hc Y H Ni ó to mi iu kin thun li cho tụi sut thi gian hc ti trng Cỏc thy cụ giỏo B mụn Nhi trng i hc Y H Ni ó ht lũng dy d, ch bo tụi quỏ trỡnh hc v lm vic Cỏc cụ, cỏc ch bỏc s, y tỏ, h lý v ton th nhõn viờn khoa Min dch D ng - Khp, bnh vin nhi Trung ng ó dnh nhiu quan tõm v giỳp quý bỏu cho tụi hon thnh lun ny Tụi xin by t lũng bit n ti PGS.TS Nguyn Th Diu Thỳy, ch nhim b mụn Nhi, phú trng khoa Min dch - D ng- Khp, cụ l ngi thy tụn kớnh, ngi ó trc tip hng dn tụi sut quỏ trỡnh lm lun tụi cú c kt qu ngy hụm Tụi xin dnh tt c lũng bit n ti b m, gia ỡnh ngi ó sinh thnh v nuụi nõng tụi, yờu thng v hy sinh rt nhiu cho thnh cụng ca tụi ngy hụm H Ni, ngy 10 thỏng 11 nm 2015 Hc viờn Nguyn Th Phng Tho LI CAM OAN Tụi l Nguyn Th Phng Tho, hc viờn bỏc s ni trỳ khúa 37Trng i hc Y H Ni, chuyờn ngnh Nhi khoa, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca PGS.TS Nguyn Th Diu Thỳy Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 10 thỏng 11 nm 2015 Hc viờn Nguyn Th Phng Tho MC LC T VN Error! 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Bookmark not defined 85 KIN NGH Bnh khp tr em ó thc s tr thnh ỏng quan tõm ca ngnh Nhi khoa Vit Nam vi s lng bnh nhõn ngy cngln, bnh cnh phc tp, khú tip cn chn oỏn sm, iu tr khú khn, l gỏnh nng bnh tt sut cuc i ca tr Cn cú nhng nghiờn cu rng v sõu hn, cú th l nhng nghiờn cu a trung tõm, mt thi gian di xõy dng mụ hỡnh bnh khp tr em, gúp phn thc hnh lõm sng cng nh ỏnh giỏ gỏnh nng bnh tt i tng nhi khoa Ngi thy thuc lõm sng cn da vo nhng c im lõm sng, cn lõm sng c trng ca tng nhúm bnh thng gp cú nh hng tip cn v chn oỏn bnh lý khp tr em TI LIU THAM KHO WHO (2003) The Burden of Musculoskeletal Conditions at the Start of the New Millennium: report of a WHO scientific group, Geneva, Switzerland Centers for Disease Control and Prevention (2013) Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation- United States, 2010- 2012, Morbidity and Mortality Weekly Report 62, pp 869-873 Helmick CG Hootman JM (2006) Projections of US prevalence of arthritis and associated activity limitations, Arthritis Rheum 54(1).pp 226-229 Nguyn Th Ngc Lan (2009).Bnh hc c xng khp ni khoa, Nh xut bn giỏo dc Vit Nam National Ambulatory Medical Care Survey (2007) Data Source: 20012004 National Ambulatory Medical Care Survey and 20012004 National Hospital Ambulatory Medical Care Survey, Arthritis Care Res 57, pp 1439-1445 Nguyn Thu Hin (2001).Nghiờn cu mụ hỡnh bnh tt ti khoa Cxng-khp bnh vin Bch Mai mi nm (1991-2000) i hc Y H Ni Mai Vn Thnh (2001) Mụ hỡnh bnh tt v t vong ti khoa nhi bnh vin a khoa tnh Gia Lai 10 nm (1991-2000), Tp Y hc thnh ph H Chớ Minh 4(5) tr 169 Thaschawee Arkachaisri (2011) Pediatric Rheumatology in Southeast Asia: Insights from the Singapore Experience, Curr Rheumatol Rep 13, pp 117-122 Charles H Spencer (2007) Why should pediatric rheumatology be recognized as a separate subspecialty: an open letter to medical councils and government agencies, Pediatric Rheumatology 10 Nguyn Vn Huy (2006) i cng v h xng- khp, Gii phu ngi, Nh xut bn Y hc, H Ni, tr 12-21 11 Barbara Janson Cohen (2007).Medical Terminology- An Illustrated Guide, Fourth Lippincott williams & wilkins, 744 12 Sujata Sawhney (2006) Paediatric rheumatology- A global perspective, Best Practice & Research Clinical Rheumatology 20(2).pp 201-221 13 Philip J Hashkes, Yosef Uziel, Moshe Rubenstein (2004) The Israeli internet- based registry: novel concept of multicenter data collection in pediatric rheumatology, Pediatric Rheumatology Online Journal 2(1).pp 37-50 14 Alan M Rosenberg (2005) Longitudinal analysis of a Pediatric Rheumatology Clinic population, The Journal of Rhematology 32(10).pp 1992-2001 15 S Bowyer, P Roettcher (1996) Pediatric rheumatology clinic populations in the United States: results of a year survey Pediatric Rheumatology Database Research Group, The Journal of Rhematology 23(11).pp 1968-1974 16 Thaschawee Arkachaisri (2004) Pediatric Rheumatology in Asia: The Thai Experience, Pediatric Rheumatology Online Journal 2(3).pp 286-294 17 Camille Aupiais (2015) Aetiology of arthritis in hospitalised children: an observational study, Archives of Disease in Childhood 0, pp 1-6 18 ỉystein Rolandsen Riise, Kai Samson Handeland (2008) Incidence and Characteristics of Arthritis in Norwegian Children: A PopulationBased Study, Pediatrics 121(2).pp e299-306 19 Nadia J.C Luca, Brian M Feldman (2014) Health outcomes of pediatric rheumatic diseases, Best Practice & Research Clinical Rheumatology 28, pp 331-350 20 Robert M Kliegman (2011).Nelson Textbook of Pediatrics, 19, Saunders/Elsevier, Philadelphia 21 Ross E Petty, Ronald M Laxer, Lucy R Wedderburn (2015) Chapter 15: Juvenile Idiopathic Arthritis, Ross E PettyRonald M Laxer, Lucy R Wedderburn, Textbook of Pediatric Rheumatology, Elservier, Philadelphia, pp 188-204 22 Maria Espinosa, BS Gottlieb (2012) Juvenile Idiopathic Arthritis, Pediatrics in Review 33, pp 303-313 23 Lucy R Wedderburn, Kiran Nistana (2009) Chapter 106: Etiology and Pathogenesis of Juvenile Idiopathic Arthritis, Gary S Firestein, Ralph C Budd, Kelley's textbook of rheumatology, Saunders/Elsevier, Philadelphia, pp 1741- 1752 24 RE Petty (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001, Journal of Rheumatology 31, pp 390-392 25 Ricardo Restrepo, Edward Y Lee (2012) Epidemiology, Pathogenesis, and Imaging of Arthritis in Children, Orthopedic Clinics of North America 43, pp 213-225 26 Hsin- Hui Yu (2013) Juvenile Idiopathic Arthritis-Associated Uveitis: A Nationwide Population-Based Study in Taiwan, PLoS ONE 8(8).pp e70625 27 Chang-Ching Shen (2012) Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria: A communitybased cohort study in Taiwan, Journal of Microbiology, Immunology and Infection xx, pp 1-7 28 A.N Chandrasekaran, C.P Rajendran, Radha Madhavan (1996) Juvenile Rheumatoid Arthritis-MadrasExperience, Indian Journal of Paediatrics 63, pp 501-510 29 Satoshi Fujikawa, Masahiko Okuni (1997) Clinical analysis of 570 cases with juvenile rheumatoid arthritis: Results of a nationwide retrospective survey in Japan,Acta Paediatrica Japonica 39, pp 245-249 30 CJ Wu (2001) Clinical characteristics of juvenile rheumatoid arthritis in Taiwan, Journal of Microbiology, Immunology and Infection 34(3).pp 211-214 31 Youn-Soo Hahn, JG Kim (2010) Pathogenesis and clinical manifestation of juvenile rheumatoid arthritis, Korean J Pediatr 53(11).pp 921-930 32 E Gunther (2009) Juvenile Idiopathic Arthritis: Classification, Clinical Presentation and Current Treatments, Hormon Reseach 72, pp 4-12 33 Femke H M Prince, Marieke H Otten, Lisette W A van SuijlekomSmit (2010) Diagnosis and management of juvenile idiopathic arthritis, BMJ 34, pp c6434 34 Eli M Eisenstein, Yackov Berkun (2014) Diagnosis and classication of juvenile idiopathic arthritis, Journal of Autoimmunity, pp 31-33 35 DS Pisetsky, JP Buyon, S Manzi (2001) Chapter 17 Systemic lupus erythematosus, JH Klippel,Primer on the Rheumatic Diseases, Arrthritis Foundation, Atlanta 36 V Rus, A Hajeer, MC Hochberg (2001) Chapter Systemic lupus erythematosus, AJ Silman, MC Hochberg, Epidemiology of the Rheumatic Disease, Oxford University Press, New York 37 N Danchenko, JA Satia, MS Anthony (2006) Lupus around the world: Epidemiology of systemic lupus erythromatosus: a comparison of worldwide disease burden, Lupus 15, pp 308-318 38 Rupert W Jakes, Sang- Cheol Bae (2012) Systematic Review of the Epidemiology of Systemic Lupus Erythematosus in the Asia-Pacic Region: Prevalence, Incidence, Clinical Features, and Mortality, Arthritis Care and Research 64(2).pp 159-168 39 JJ Sacks, CG Helmick (2002) Trends in deaths from systemic lupus erythematosus- United States, 1979-1988, MMWR 51(17).pp 371-374 40 Charles G Helmick, David T Felson, Reva C Lawrence (2008) Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States: Part I, Arthritis and Rheumatism 58(1).pp 15-25 41 SD Sule, DG Moodalbail (2015) Predictors of arthritis in pediatric patients with lupus, Pediatric Rheumatology 13(30) 42 Jane E Salmon, Robert P Kimberly (2006) Systemic Lupus Erythematosus, SA Paget, Manual of Rheumatology and Outpatient Orthopedic Disorders, Lippincott William and Wilkins, Philadelphia 43 FE Mackie, G Kainer (2015) The national incidence and clinical picture of SLE in children in Australia a report from the Australian Paediatric Surveillance Unit, Lupus 24, pp 66-73 44 Marisa Klein- Gitelman, Jerome Charles Lane (2015) Chapter 23: Systemic Lupus Erythematosus, Ross E Petty,Textbook of Pediatric Rheumatology, Elservier, Philadelphia 45 Samuel Weinberg, Neil Prose, Kristal (2008).Color Atlas of Pediatric Dermatology: 4th edition, McGraw Hill 46 Maria Dallera, David Wofsy (2013) Chapter 80: Clinical Features of Systemic lupus erythematosus, Gary S Firestein, Ralph C Budd, Kelley's Textbook of Rheumatology, Saunders/Elsevier, Philadelphia 47 Yao-Hsu Yang, Hsin-Hui Yu, Bor-Luen Chiang (2014) The diagnosis and classification of Henoch- Schonlein purpura: An updated review, Autoimmunity Reviews, pp 48 Pamela F Weiss (2012) Pediatric Vasculitis, Pediatric Clinics of North America 59(2).pp 407-423 49 O Chen, XB Zhu, DE Wei (2013) Henoch Schonlein Purpura in children: clinical analysis of 120 cases, African Health Sciences 13(1).pp 94-99 50 Sandra Trapani, Annalisa Micheli (2005) Henoch Schonlein Purpura in Childhood: Epidemiological and Clinical Analysis of 150 Cases Over a 5-year Period and Review of Literature, Seminars in Arthritis and Rheumatism 35, pp 143-153 51 Yilmaz Tabel, Filiz Callak Inanc (2012) Clinical Features of Children With Henoch-Schonlein Purpura Risk Factors Associated With Renal Involvement, Kidney diseases 6, pp 269-274 52 Louise Watson, Amanda R.W Richardson (2012) Henoch Schonlein Purpura A 5-Year Review and Proposed Pathway, PLoS ONE 7(1) 53 Mojgan Safari, Arash Dehghan (2013) Hemorrhagic bullous lesions in a 4-year-old girl with Henoch-Schửenlein purpura, Indian Journal of Paediatric Dermatology 14(3).pp 88-91 54 Michelle Petri, Ana- Maria Orbai (2012) Derivation and Validation of Systemic Lupus International Collaborating Clinics Classification Criteria for Systemic Lupus Erythematosus, Arthritis and Rheumatism 64(8).pp 2677-2686 55 Yashwant Singh Tanwar (2014) Acute pediatric septic arthritis: A systematic review of literature and current controversys, Polish Orthopedics and Traumatology 79, pp 23-29 56 Paul P Cook, Dawd S Siraj (2013) Chapter 109: Bacterial Arthritis, Gary S Firestein, Kelley's Textbook of Rheumatology, Saunders/ Elsevier, Philadelphia 57 Thomas J.A Lehman (2006) Childhood Rheumatic Disease, SA Paget, Manual of Rheumatology and Outpatient Orthopedic Disorders, Lippincott William and Wilkins, Philadelphia, pp 275-284 58 Christopher Wall, Leo Donnan (2015) Septic arthritis in children, Australian Family Physician 44(4).pp 213-215 59 Diane Lewis Horowitz, Elena Katzap (2011) Approach to Septic Arthritis, Am Fam Physician 84(6).pp 653-660 60 Y- H Yang, C- F Hung, C- R Hsu (2005) A nationwide survey on epidemiological characteristics of childhood HenochSchonlein purpura in Taiwan, Rheumatology 44, pp 618- 622 61 L Eder, D Zisman, M Rozenbaum (2005) Clinical features and aetiology of septic arthritis in northern Israel, Rheumatology 44, pp 1559-1563 62 Stacy P Ardoin, Edward Fels (2011) Chapter 161.1 HenochSchonlein Purpura, Robert M Kliegman, Bonita F Stanton, Joseph W St Geme, Nelson textbook of Pediatrics 19th edition, Elsevier, Philadelphia 63 Satoshi Fujikawa, Masahiko Okuni (1997) A nationwide surveillance study ofrheumatic diseases among Japanese children, Acta PaediatricaJaponica 39, pp 242- 244 64 DP Symmons, M Jones, J Osborne (1996) Pediatric rheumatology in the United Kingdom: data from the British Pediatric Rheumatology Group National Diagnostic Register, The Journal of Rhematology 23, pp 1975-1980 65 E.F Johnson, J.S Lehman, D.A Wetter (2014) Henoch-Schonlein purpura and systemic disease in children: Retrospective study of clinical findings, histopathology, and direct immunofluorescence in 34 pediatric patients, British Journal of Dermatology 66 Louise Watson, Amanda R W Richardson, Michael W Beresford (2012) Henoch Schonlein Purpura- A 5-year Review and Proposed Pathway, PLoS ONE 7(1).pp e29512 67 Le Quynh Chi (2015).Nghiờn cu c im lõm sng v mt s du n sinh hc bnh viờm khp t phỏt thiu niờn, i hc Y H Ni, H Ni 68 Ellen Nordal (2011) Ongoing Disease Activity and Changing Categories in a Long-Term Nordic Cohort Study of Juvenile Idiopathic Arthritis, Arthritis and Rheumatism 63(9).pp 2809-2818 69 Kate Weakley, Monica Esser, Christian Scott (2012) Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa, Pediatric Rheumatology 10(35) 70 Samia Naz (2013) Juvenile Rheumatoid Arthritis, Journal of the College of Physicians and Surgeons Pakistan 23(6).pp 409-412 71 James Chipeta (2013) Clinical patterns of juvenile idiopathic arthritis in Zambia, Pediatric Rheumatology 11(33) 72 Kimme L Hyrich, Sham D Lai, Helen E Foster (2009) Disease activity and disability in children with juvenile idiopathic arthritis one year following presentation to paediatric rheumatology Results from the ChildhoodArthritis Prospective Study, Rheumatology 73 Kiem Oen, Ciaran M Duffy, Shirley M.L Tse (2010) Early Outcomes and Improvement of Patients With Juvenile Idiopathic Arthritis Enrolled in a Canadian Multicenter Inception Cohort, Arthritis Care and Research 62(4).pp 527-536 74 Yukihiko Kawasaki, Atsushi Ono (2013) Henoch-Schonlein purpura nephritis in childhood: Pathogenesis, prognostic factors and treatment, Fukushima J Med Sci 59(1).pp 15-26 75 J.-F Wu, Y.-H Yang, L.-C Wang (2007) Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in juvenile rheumatoid arthritis, Clinical and Experimental Rheumatology 25, pp 782-785 76 WD Blackburn (1994) Validity of acute phase proteins as markers of disease activity, The Journal of Rhematology 42, pp 9-13 77 Jeana Hong, Hye Ran Yang (2015) Laboratory Markers Indicating Gastrointestinal Involvement of Henoch-Schửnlein Purpura in Children, Pediatr Gastroenterol Hepatol Nutr 18(1).pp 39-47 78 Mei-Chen Teng, Li-Chieh Wang, Hsin-Hui Yu (2012) Kawasaki disease and HenocheSchonlein purpura e 10 years experience of childhood vasculitis at a university hospital in Taiwan, Journal of Microbiology, Immunology and Infection 45, pp 22-30 79 Arenda J.W Haasnoot, Maretta Van Tent-Hoeve, Nico M Wulffraat (2015) Erythrocyte Sedimentation Rate as BaselinePredictor for the Development of Uveitis inChildren With Juvenile Idiopathic Arthritis, American Journal of Ophthalmology 159(2).pp 372-377 80 BE Gilliam (2008) Measurement of biomarkers in juvenile idiopathic arthritis patients and their significant association with disease severity: a comparative study, Clinical and Experimental Rheumatology 26(3).pp 492-497 81 Sabrina Boodhan, Jeremy N Friedman (2009) Naproxen-Induced Anemia and Hypoalbuminemia in a 16-Month-Old Child, Clinical Pediatrics 48, pp 96-98 82 T Mason (2005) Radiographic progression in children with polyarticular juvenile rheumatoid arthritis: a pilot study, Ann Rheum Dis 64, pp 491-493 83 L Berntson (2008) HLA-B27 predicts a more extended disease with increasing age at onset in boys with juvenile idiopathic arthritis, Journal of Rheumatology 35(10).pp 2055-2061 84 Lennart Truedsson, Anders A Bengtsson, Gunnar Sturfelt (2007) Complement deficiencies and Autoimmunity 40(8).pp 560-566 systemic lupus erythematosus, Mó s nghiờn cu: Mó s bnh ỏn: BNH N NGHIấN CU I- HNH CHNH H tờn: Gii: Nam N Ngy sinh: a ch: ST: Ngy CX: Ngy vv: Ngy vin: II- TIN S A Gia ỡnh: B M Anh ch em Bnh khp Vy nn Bnh h thng B Bn thõn Sn khoa: Con th: Dinh dng Tiờm chng: Bnh tt: Chn thng Cõn nng lỳc sinh: (g) Bnh khp Vy nn Bnh h thng (SLE, SH) Bnh khỏc (Thp tim) C Thụng tin v cỏc t bnh khp S t bnh: Thi im xut hin 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