To assess the long-term effects of juvenile idiopathic arthritis in adulthood, unified diagnostic methods for articular and extra-articular lesions should be used which depend on the juvenile idiopathic arthritis variants, the disease activity and treatment.
The objective of the research was to compare the clinical manifestations in adult patients with different juvenile idiopathic arthritis-specific immunogenic markers and to evaluate their impact on the long-term articular and extra-articular damage.
Materials and methods. We observed 132 young patients with different juvenile idiopathic arthritis variants. According to genetic/immunological markers the following groups were formed: Group I - 38 positive human leukocyte antigen B27 patients; Group II - 13 positive antinuclear antibody patients; Group III - 26 positive rheumatoid factor/anti-cyclic citrullinated peptide patients and Group IV - 55 patients with all negative markers. Long-term effects of juvenile idiopathic arthritis were estimated by the articular juvenile arthritis damage index (JADI-A) and the extra-articular juvenile arthritis damage index (JADI-E). Descriptive statistics, the Student’s T-test, the Fisher’s exact test and Mann-Whitney U-test were performed.
Results. 70 women and 62 men with the disease duration of 13.6±9.3 years at the age of 24.3±8.3 years were included into the study: 12 (9.1%) patients with positive rheumatoid factor polyarthritis, 30 (22.7%) patients - with negative rheumatoid factor polyarthritis, 32 (24.2%) patients with persistent oligoarthritis, 19 (14.4%) patients with extendent oligoarthritis, 20 (15.2%) patients with entesitis-related arthritis and 19 (14.4%) patients with systemic arthritis; there were no patients with psoriatic arthritis. There were no differences between groups in age, disease-modifying antirheumatic drug cumulative dose, mean dose of prednisolone and quality of life according to the SF-36. In Group I, the delay in the diagnosis was more than one year (18.6±24.2 months). In this group, less painful (p<0.005) and deformed (p<0.01) joints as compared to Group ІІІ, and higher levels of the ESR and C-reactive protein as compared to Group ІV were found, although the Juvenile Arthritis Disease Activity Score index in childhood was lower (p<0.005) as compared to Group ІІ. They received a lower cumulative dose of the glucocorticoids as compared to Group II (p<0.01), respectively. They had lower (p<0.01) JADI-E as compared to Group II (1.31 ± 1.49) and lower (p <0.01) JADI-A as compared to Group III. In Group III, the diagnosis was made the fastest in comparison with other groups (6.4±8.4 months, p<0.05); more painful joints (p <0.05) and ankylosis (p<0.05) were observed as compared to Group I, JADI-A was significantly higher (p<0.05) in Group III as compared to Group I. The most pronounced JADI-A was found in Group III, while in Group I and Group II, this index was the lowest. JADI-E was the most pronounced in Group II, and the most favorable course was found in Group І and Group ІІІ (p<0.05).
Conclusions. Presence of anti-cyclic citrullinated peptide/rheumatoid factor in adults with juvenile idiopathic arthritis has negative impact on joint damage (JADI-A) indicating the need for aggressive therapy in both childhood and adulthood. Presences of antinuclear antibodies are associated with more often extra-articular damages in adulthood as compared to other groups.
Consolaro A, Ruperto N, Bazso A et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum. 2009;(61):658-666. DOI: https://doi.org/10.1002/art.24516
Ferraccioli G, Tolusso B, Fedele AL, Gremese E. Do we need to apply a T2T strategy even in ACPA-negative early rheumatoid arthritis? YES RMD Open. 2016;2(1):e000263. DOI: https://doi.org/10.1136/rmdopen-2016-000263
Flatø B, Aasland A, Vinje O, Førre O. Outcome and predictive factors in juvenile rheumatoid arthritis and juvenile spondyloarthropathy. J Rheumatol. 1998;(2):366-375. [PMid:9489836]
Magni-Manzoni S, Rossi F, Pistorio A et al. Prognostic factors for radiographic progression, radiographic damage and disability in juvenile idiopathic arthritis. Arthritis Rheum 2003;(48):3509-3517. DOI: https://doi.org/10.1002/art.11337
Oliveira-Ramos F, Eusébio M, Martins FM et al. Juvenile idiopathic arthritis in adulthood: fulfilment of classification criteria for adult rheumatic diseases. long-term outcomes and predictors of inactive disease, functional status and damage. RMD Open 2016;(2):e000304 DOI: https://doi.org/10.1136/rmdopen-2016-000304
Packham JC, Hall MA. Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology (Oxford). 2002;(41):1428-1435. DOI: https://doi.org/10.1093/rheumatology/41.12.1428
Petty RE, Southwood TR, Manners P et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton 2001. J. Rheumatol. 2004;31(2):390-392. [PMid:14760812]
Ruperto N, Ravelli A, Levinson JE et al. Long-term health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. II. Early predictors of outcome. J Rheumatol 1997;(24):952-958. [PMid:9150088]
Selvaag A, Aullie H, Lilleby V et al. Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis. 2014;(10):1-6.
Susic GZ, Stojanovic RM, Pejnovic NN et al. Analysis of disease activity, functional disability and articular damage in patients with juvenile idiopathic arthritis: a prospective outcome study. Clin Exp Rheumatol 2011;(29):337-344. [PMid:21385554]
Van der Helm-van Mil AH. Risk estimation in rheumatoid arthritis: from bench to bedside. Nat Rev Rheumatol. 2014;(10):171-180. DOI: https://doi.org/10.1038/nrrheum.2013.215 [PMid:24468938]
Viola S, Felici E, Magni-Manzoni S et al. Development and validation of a clinical index for assessment of long-term damage in juvenile idiopathic arthritis. Arthritis Rheum. 2005;(52):2092-2102. DOI: https://doi.org/10.1002/art.21119
Zak M, Pedersen FK. Juvenile chronic arthritis into adulthood: a long-term follow-up study. Rheumatology (Oxford). 2000;(39):198-204. DOI: https://doi.org/10.1093/rheumatology/39.2.198
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