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The importance of small joint involvement in oligoarticular juvenile idiopathic arthritis

Melike Mehveş Kaplan¹, Zahide Ekici Tekin¹, Vildan Güngörer¹

¹Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey.

Modern Rheumatology

|October 14, 2023

Insights

Small joint involvement in oligoarticular juvenile idiopathic arthritis (oJIA) is linked to higher inflammatory markers and a more prolonged disease course. These patients often require escalated treatment, including disease-modifying antirheumatic drugs.

Area of Science:

Pediatric Rheumatology
Immunology
Clinical Medicine

Background:

Oligoarticular juvenile idiopathic arthritis (oJIA) is a chronic autoimmune condition affecting joints in children.
Understanding factors influencing oJIA prognosis is crucial for effective management.

Purpose of the Study:

To investigate the association between small joint involvement and patient characteristics in oJIA.
To determine the impact of small joint involvement on disease activity and prognosis.

Main Methods:

Retrospective observational study of 198 oJIA patients.
Analysis of demographic, clinical, and laboratory data.
Statistical methods to assess relationships and outcomes.

Main Results:

Small joint involvement occurred in 10% of oJIA patients, more frequent in extended vs. persistent oJIA.
Patients with small joint involvement showed higher acute phase reactants (ESR, CRP) and JADAS scores.
Increased need for conventional and biologic disease-modifying antirheumatic drugs (DMARDs) observed.

Conclusions:

Small joint involvement in oJIA may indicate a more severe disease phenotype.
These patients often present with elevated inflammatory markers and require more intensive treatment strategies.
Small joint involvement is associated with a prolonged disease course and potential need for treatment escalation.

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Abstract

Objectives:

Our study aimed to evaluate the relationship of small joint involvement with demographic, clinical, and laboratory findings and to determine its possible effects on prognosis.

Methods:

This retrospective observational study was conducted in patients diagnosed with oligoarticular juvenile idiopathic arthritis (oJIA) in the paediatric rheumatology department of Ankara City Hospital between April 2009 and September 2022. The relationship between small joint involvement and demographic, clinical, and laboratory findings and prognosis was investigated by statistical methods with the data recorded from the medical records of oJIA patients.

Results:

Of the 198 patients diagnosed with oJIA, small joint involvement was observed in a total of 20 (10%) patients, 11 (5.5%) at the time of diagnosis, and 9 (4.5%) during the follow-up period. The frequency of small joint involvement in extended oJIA was significantly higher than in persistent oJIA (P = .001). Patients with small joint involvement had significantly higher erythrocyte sedimentation rate and C-reactive protein values at admission (P = .047, P = .038) and Juvenile Arthritis Disease Activity Score at 3, 6, and 12 months (P = .001, P = .001, P = .018). The need for conventional disease-modifying antirheumatic drugs and biologic disease-modifying antirheumatic drugs was significantly higher in patients with small joint involvement (P = .001, P = .001).

Conclusions:

oJIA patients with small joint involvement may have higher acute phase reactants at diagnosis, a more extended course and active disease in follow-up, and the need for treatment escalation.

Keywords:

Juvenile idiopathic arthritis oligoarthritis prognosis small joint arthritis small joint involvement

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