Background Juvenile idiopathic arthritis (JIA) is a heterogeneous inflammatory disease that persists in about half the cases into adulthood. Little is known about the morbidity spectrum of adult patients with JIA.
Objectives To assess the prevalence of self-reported lifetime comorbidities in adult patients with JIA who received etanercept during childhood, and to analyze the impact of comorbidity on the patients’ subjectively perceived health state.
Methods Self-reported comorbidity was studied in 278 adult JIA patients who were ever treated with etanercept and recorded in the biologic register JuMBO (Juvenile arthritis Methotrexate/Biologics long-term Observation). Comorbidity prevalence among the patients was compared to an age- and sex-matched control cohort from the population. The association of disease parameters with the presence of any comorbid condition was analyzed by linear or logistic regression models.
Results Sixty two percent of the adult JIA patients reported at least one comorbid condition 11 years (median) after disease onset. Uveitis was the most frequent comorbid condition (19.3%), followed by allergic rhinitis (14.0%), migraine (8.6%), and atopic dermatitis (7.9%). In the whole group, the prevalence of cardiovascular diseases was 10.8% which was not higher than the corresponding rate in a control cohort from the general population. However, patients with systemic onset of JIA (soJIA) had a significantly higher rate of cardiovascular diseases of 43% (p=0.042). In general, patients with soJIA had the highest prevalence of comorbidities (79%) as compared to patients with other JIA subgroups, and the highest mean number of comorbidities (1.9) as well.
Comorbidities were significantly associated with the number of DMARDs received by the patients and the presence of antinuclear antibodies. Age, gender, disease duration, HLA-B27 positivity, and the duration of etanercept treatment had no significant influence on the presence of a comorbid condition. Patients who reported at least one comorbid condition had a significantly higher disease activity (p=0.002), suffered more often from fatigue (p<0.001) and pain (p<0.001), had a lower functional capacity (p<0.001), and valued their health-related quality of life lower (p<0.001) than those without any comorbidity. The comorbidity status (p<0.001) and disease activity (p<0.001) were independent predictors of a lower HRQoL.
Conclusions Our results indicate that comorbid conditions have a significant impact on the subjectively perceived health state in adult JIA. Among all JIA patients those with systemic onset of JIA carry the highest risk for comorbidities, in particular for cardiovascular disorders.
Supported by an unrestricted grant from Pfizer Pharma GmbH.
Disclosure of Interest A. Raab: None Declared, C. Sengler: None Declared, M. Niewerth: None Declared, J. Klotsche: None Declared, G. Horneff Grant/Research support from: Pfizer,Abbott, A. Zink: None Declared, H. Girschick: None Declared, K. Minden Grant/Research support from: Pfizer