Physical disability, articular, and extra-articular damage in patients with juvenile idiopathic arthritis

Data on outcome of juvenile idiopathic arthritis (JIA) from the Indian subcontinent is limited. Juvenile Arthritis Damage Index (JADI) is a newly proposed index which measures articular (JADI-A) and extra-articular damage (JADI-E). We studied the outcome of JIA using JADI in Indian patients. We assessed the damage in patients with JIA using JADI, and to see if JADI scores correlate with various parameters of damage and disease activity. We studied 89 patients of JIA (excluding enthesitis-related arthritis) with a >or=1-year duration of the disease. Besides JADI, clinical assessment included active joint count, joints with limited mobility, ESR, and CHAQ. Radiological damage was assessed according to the Dale scoring system. Correlation of JADI with various parameters was done by Spearman's rank correlation coefficient. The patient's distribution of JIA subtypes was polyarticular (47), systemic onset (SoJIA 23), oligoarticular (15), psoriatic arthritis (one) and others (three). The median duration of disease was 5 years (1-20). JADI-A ranged from 0-61 (Median 2); 60.7% of children had articular damage. Thirty-five (39.3%) patients had extra-articular damage; out of which, growth failure was the commonest. Persistent oligoarticular subtype had lesser JADI-A score as compared to SoJIA and polyarticular JIA. JADI-A correlated significantly with (p<0.01) with radiological damage (0.538), CHAQ (0.567), JADI-E (0.513), duration of disease (0.385), and loss of education years due to disease (0.352). Further it also correlated with measures of disease activity like: ESR (0.286), duration of morning stiffness (0.258, p<0.05), physician's global assessment (rS 0.623), and parent's global assessment (0.446), Almost two-thirds of patients with JIA had articular damage and one third had extra-articular damage. JADI is a good tool to measure damage in children with JIA.