Remission and Active Disease in Young Adult Patients with Juvenile Idiopathic Arthritis During the Transition Period from Paediatric to Adult Healthcare
PDF

Keywords

juvenile idiopathic arthritis
remission
activity
quality of life
therapy

How to Cite

Dzhus, M. (2018). Remission and Active Disease in Young Adult Patients with Juvenile Idiopathic Arthritis During the Transition Period from Paediatric to Adult Healthcare. Galician Medical Journal, 25(3). https://doi.org/10.21802/gmj.2018.3.2

Abstract

The objective of the research was to study the frequency of remission in young adults with juvenile idiopathic arthritis during the transition period from paediatric to adult healthcare and factors contributing to its development.

         Materials and methods. In our study, there were included 165 adult patients from different regions of Ukraine diagnosed with juvenile idiopathic arthritis according to the classification criteria of the International League of Associations for Rheumatology. All the patients were examined in the Oleksandrivska City Clinical Hospital, Kyiv during 2015-2018. There were assessed the presence of rheumatoid factor, anti-cyclic citrullinated peptide, antinuclear antibodies, human leukocyte antigen B27, disease duration, disease activity (the Juvenile Arthritis Disease Activity Score-10 and the Disease Activity Score-28), C-reactive protein, past medical history, quality of life (the 36-Item Short Form Health Survey), the degree of depression (the Patient Health Questionnaire-9) and alexithymia (the 20-item Toronto Alexithymia Scale). In all the patients, bone mineral density was studied using dual-energy x-ray absorptiometry with the evaluation of T- and Z-scores in different regions of the skeleton. The disease was considered inactive at the Disease Activity Score-28 <2.6 and the Juvenile Arthritis Disease Activity Score-10 <1 and <2 for oligoarticular and polyarticular variants of juvenile idiopathic arthritis, respectively.

         Results and discussion. All the patients were divided into 2 groups: Group I included 136 (82.4%) patients with active disease at the time of examination; Group II comprised 29 (17.6%) patients who achieved remission according to the Disease Activity Score-28 or the Juvenile Arthritis Disease Activity Score-10. In Group I, females prevailed accounting for 58.1% of patients as compared to Group II (31.0%). Disease duration was longer in patients of Group I (p<0.01); however, they did not differ from patients of Group II in age at disease onset and the International League of Associations for Rheumatology variants of juvenile idiopathic arthritis. In Group II, lesions involving more than 3 joints (p<0.01), hand arthritis (p<0.01), symmetric arthritis (p<0.01), enthesitis (p<0.01), spinal pain (p<0.01) were observed less frequently. Fewer patients required joint replacement (p<0.01); the number of deformed and painful joints (p<0.05, p<0.001, respectively) was smaller. However, there was no difference in the level of rheumatoid factor, anti-cyclic citrullinated peptide, antinuclear antibodies, and the presence of human leukocyte antigen B27. The achievement of remission improved physical well-being of patients (the physical component score, p<0.001), although overall mental well-being (the mental component score) did not change according to the 36-Item Short Form Health Survey. In patients with remission, the indicators of physical functioning (p<0.001), role functioning (p<0.001), social functioning (p<0.001), bodily pain (p<0.001), general health (p<0.001), mental health (p<0.001) improved. There was observed a reduction in the level of depression to the normal one according to the Patient Health Questionnaire-9 (p<0.05); however, in both groups, there were observed elevated levels of alexithymia. Both groups did not differ in the frequency of immunobiological therapy prescription; however, the results should be intepreted with caution, since only 5 (17.1%) patients in Group II received immunobiological therapy earlier or at the time of examination. In Group II, patients did not receive glucocorticoids at the time of examination (p<0.001) and earlier more often (p<0.001). Both groups did not differ in both the duration of treatment with disease-modifying antirheumatic drugs and the doses of methotrexate and sulfasalazine.

         Conclusions. Remission of juvenile idiopathic arthritis was detected in 17.6% of the surveyed young adult patients from different regions of Ukraine during the transition period from paediatric to adult healthcare, that indicated that in most cases the goal of treat-to-target strategy was not achieved. Patients with active disease often developed joint deformities and required their replacement; they had worse physical well-being according to the 36-Item Short Form Health Survey, although mental well-being was affected in both patients with active disease and those with remission, which may be due to high levels of alexithymia in both groups. Patients with active disease had higher levels of depression according to the Patient Health Questionnaire-9, whereas patients in remission showed no depression.

 

https://doi.org/10.21802/gmj.2018.3.2
PDF

References

Kovalenko VM, Shuba NM, Yaremenko OB et al. Substantiation report concerning retention of diagnosis “juvenile rheumatoid arthritis” status in adult patients with a disease onset in childhood and adolescence. Ukr. revmatol. zhurnal. 2016;63:5-7. [published in Ukrainian].

Ammerlaan JW, Scholtus LW, Bijlsma HJ et al. An urge for change: transitional care for young adults with juvenile idiopathic arthritis. Patient Educ Couns. 2013;92:127-129. DOI: https://doi.org/10.1016/j.pec.2013.02.006 [PMid:23490174]

Barth S, Haas J-P, Schlichtiger J et al. Long-Term Health-Related Quality of Life in German Patients with Juvenile Idiopathic Arthritis in Comparison to German General Population. PLoS ONE. 2016;11(4): e0153267. DOI: https://doi.org/10.1371/journal.pone.0153267

Bertilsson L, Andersson-Gare B, Fasth A et al. Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years. J Rheumatol. 2013;40(5):715-724. DOI: https://doi.org/10.3899/jrheum.120602

Consolaro A, Giancane G, Schiappapietra B et al. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2016;14:23. doi.org/10.1186/s12969-016-0085-5. DOI: https://doi.org/10.1186/s12969-016-0085-5

Dzhus MB, Mostbauer HV, Karasevska TA, Ivashkivskyi OI. Long-term effects of articular and extra-articular damage in adult patients with juvenile rheumatoid arthritis with different immunogenic markers. Galic'kij likars'kij visnik. 2017;24(3):7-11. DOI: https://doi.org/10.21802/gmj.2017.3.15

Guillaume S, Prieur AM, Coste J et al. Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis. Arthritis Rheum. 2000;43(8):1858-1865. DOI: https://doi.org/10.1002/1529-0131(200008)43:8<1858::AID-ANR23>3.0.CO;2-A

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]

Prevoo ML, van Gestel AM, van T Hof MA et al. Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the Disease Activity Score. Br J Rheumatol. 1996;35:1101-1105. DOI: https://doi.org/10.1093/rheumatology/35.11.1101

Ravelli A, Martini A. Remission in juvenile idiopathic arthritis. Clin Exp Rheumatol. 2006;24(43):105-110.

Scal P, Horvath K, Garwick A. Preparing for adulthood: health care transition counseling for youth with arthritis. Arthritis Rheum. 2009;61(1):52-57. DOI: https://doi.org/10.1002/art.24088

Wu Q, Chaplin H, Ambrose N et al. Juvenile arthritis disease activity score is a better reflector of active disease than the disease activity score 28 in adults with polyarticular juvenile idiopathic arthritis. Ann Rheum Dis. 2016;75(3):635-636. DOI: https://doi.org/10.1136/annrheumdis-2015-208462

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.