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Disease evolution in systemic juvenile idiopathic arthritis: an international, observational cohort study through
M Wallimann1, K Bouayed2,3, E Cannizzaro4
1Department of Woman, Mother, Child, Unit of Pediatric Immunology, Allergology and Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Insights
Early disease onset, persistent arthritis in the first year, and the need for synthetic disease-modifying antirheumatic drugs (sDMARDs) may predict a persistent course in systemic juvenile idiopathic arthritis (systemic JIA) patients.
Area of Science:
- Rheumatology
- Pediatric Rheumatology
- Immunology
Background:
- Systemic juvenile idiopathic arthritis (systemic JIA) is a severe autoimmune condition characterized by systemic and joint inflammation.
- Understanding disease evolution is crucial for managing systemic JIA and improving patient outcomes.
Purpose of the Study:
- To identify predictors of disease course in children with systemic JIA.
- To analyze factors associated with monophasic, polyphasic, or persistent disease activity.
Main Methods:
- An observational cohort study involving 201 children across 4 countries (2005-2019).
- Utilized retrospectively and prospectively collected routine care data.
- Classified patients into monophasic, polyphasic, or persistent disease groups based on 24-month follow-up data.
Main Results:
- Sixty-five patients had complete 24-month follow-up data.
- The persistent disease group (n=36) was more likely to have onset before age 6, persistent arthritis at 12 months, and higher synthetic DMARD (sDMARD) use.
- Physician/patient global assessments and CRP levels at 12 months lacked predictive value after adjustment.
Conclusions:
- Earlier disease onset, persistent arthritis within the first year, and the requirement for sDMARDs are potential predictors of a persistent disease course in systemic JIA.
- These findings aid in predicting long-term outcomes for children with systemic JIA.
Background:
Systemic juvenile idiopathic arthritis (systemic JIA) is a severe disease with both systemic and joint inflammation. This study aims to identify predictors of disease evolution within the systemic JIA population enrolled in the Juvenile Inflammatory Rheumatism cohort (JIRcohort).
Methods:
Observational patient cohort study with 201 recruited children from 4 countries (3 European, 1 North Africa) from 2005 until 2019, using retrospectively (2005-2015) and prospectively (2015-2019) routine care collected data.
Results:
Sixty-five patients with complete follow-up data for 24 months after first diagnosis were classified as monophasic (n = 23), polyphasic (n = 6) or persistent group (n = 36) corresponding to their evolution (unique flare, recurrent flares, or persistent disease activity respectively). The patients of the persistent group were more likely to have an earlier disease onset, before the age of 6 (OR 2.57, 95%-CI 0.70-9.46), persistence of arthritis at 12-months post-diagnosis (OR 4.45, 95%-CI 0.58-34.20) and higher use of synthetic DMARD (sDMARD, OR 5.28, 95%-CI 1.39-20.01). Other variables like global assessment by physician and by patient and C Reactive Protein levels at 12-months post-diagnosis were assessed but without any predictive value after adjusting for confounding factors.
Conclusions:
Our results suggest that the earlier disease onset, the persistence of arthritis throughout the first year of disease evolution and the need of sDMARD might predict a persistent disease course.
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