Prognostic factors in juvenile chronic arthritis

We evaluated 96 patients (50 males, 46 females) with juvenile chronic arthritis (JCA) for various prognostic factors in an adult rheumatology clinic. Although the onset of JCA occurred before the age of 15 in all cases, the majority had a juvenile or late onset of disease. The mean duration of disease was 14 years. Twenty-eight % had a monoarticular onset, 26% a pauciarticular, 28% a polyarticular and 14% a spondylarthropathic onset. HLA-B27 was positive in 52% of the cases, 35 males and 12 females, and HLA-DW4 was present in 10%; 11.5% were ANA positive and 4% were found rheumatoid factor positive (latex greater than 1/128). Patients were classified in functional classes, using a slight modification of Steinbrocker's criteria. Patients who underwent major orthopaedic surgery of the hip or knee were classified in functional class IV, although they actually showed better function. Twenty-seven % had a functional class I, 45% class II and 24% class III-IV at the latest evaluation. In the group with poor prognosis (functional class III and IV) there were significantly more cases with a persistently high erythrocyte sedimentation rate; polyarticular involvement at onset and at the time of their last evaluation; and a family history of rheumatic diseases. There were significantly more females in the poor prognosis group. The presence of HLA-B27 and an ANA positive test were not significantly different in the functional class groups. HLA-B27 did not predict the development of typical ankylosing spondylitis but was associated with pauciarticular peripheral arthritis with or without mild spondylitis.