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Disease Damage in Juvenile Idiopathic Arthritis
Ruksana Sidhique1, Narendra Kumar Bagri2, Manisha Jana3
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Nearly half of children with juvenile idiopathic arthritis (JIA) experience joint damage. Rheumatoid factor (RF) and anti-CCP positivity increase the risk of this damage in pediatric JIA patients.
Area of Science:
- Pediatric Rheumatology
- Clinical Immunology
- Musculoskeletal Health
Background:
- Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease affecting children.
- Disease-related damage is a significant concern in JIA, particularly in resource-limited settings.
- Understanding the prevalence and predictors of damage is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of disease-related articular and extra-articular damage in children with JIA.
- To identify predictors associated with disease-related damage in pediatric JIA patients.
- To assess damage in a resource-limited context.
Main Methods:
- A single-centre study enrolled 105 children (≤18 years) with JIA diagnosed by ILAR criteria and disease duration >1 year.
- Articular and extra-articular damage assessed using the Juvenile Arthritis Damage Index (JADI) and modified JADI scores.
- Disease activity and disability evaluated using cJADAS and CHAQ scores.
Main Results:
- 48.6% of children with JIA had articular damage, and 21.9% had extra-articular damage.
- Children with positive rheumatoid factor (RF) and/or anti-cyclic citrullinated peptides (CCPs) showed significantly higher odds of articular damage (OR: 4.4).
- Half of children with enthesitis-related arthritis (ERA) experienced joint damage; four children had ocular damage from uveitis.
Conclusions:
- A substantial proportion of children with JIA suffer from articular and extra-articular damage.
- RF and/or anti-CCP positivity are key predictors of increased joint damage in pediatric JIA.
- These findings highlight the need for early detection and intervention in resource-limited settings.
Objectives:
To estimate the prevalence and predictors of disease-related damage in children with juvenile idiopathic arthritis (JIA) in a resource-limited setting.
Methods:
A single-centre study was conducted from January 2021 - December 2022. Children (≤ 18 y) diagnosed with JIA as per International League of Associations for Rheumatology (ILAR) criteria, with a disease duration of more than one year, were enrolled for this study. The articular and extra-articular damage was assessed using the juvenile arthritis damage index (JADI) and modified JADI scores. Disease activity and disabilities were evaluated using the clinical juvenile arthritis disease activity score (cJADAS) and Childhood Health Assessment Questionnaire (CHAQ).
Results:
One hundred and five children [44% (n = 42) boys] with JIA were enrolled in the study. The mean (SD) age of children at enrolment was 158 (46.2) mo. The median (IQR) disease duration was 48 (36-72) mo. Articular damage (JADI score ≥ 1) was present in 48.6%, and extra-articular damage (JADI-E ≥ 1) was observed in 21.9% of children. Half of the children (n = 22) with enthesitis-related arthritis (ERA) had joint damage (modified JADI score ≥ 1). Four children had ocular damage due to uveitis. Among the factors associated with articular damage, the odds of articular damage were high in those with positive rheumatoid factor (RF) and/ or anti-cyclic citrullinated peptides (CCPs) [OR: 4.4, 95% CI (1.00-19.60)].
Conclusions:
48.6% of children with JIA had articular damage, while 21.9% of the children had extra-articular damage. Children with RF and/ or anti-CCP positivity are associated with higher odds of joint damage.
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