Background We run a pediatric rheumatology service at a tertiary level hospital. We follow a policy of “treat to target”.We systematically studied the JIA patients who followed up in the unit from 2009 September to 2012 January.
Objectives 1. To study the clinical profile of patients with JIA. 2. To evaluate the disease outcome at follow up using the Wallace criteria into:active disease (AD), inactive disease (ID), clinical remission on medication (CRM) and clinical remission off medication (CROM) (1). 3. To correlate factors that may impact outcome.
Methods JIA patients who had completed≥6 months of followup were included. All data, including the core set (2), were collected on standardised proformas.
Results Demographics: Of 267 patients, 59% were boys. JIA subcategories: ERA37.8%,SJIA 22.8%, OJIA 13.8%, polyarticular 12.7%, seropositive polyarticular7.8%,unclassifiable 3.8% and PsJIA (psoriatic JIA) 1.1%. Median age at disease onset for the cohort was 8 yrs range 0.58-16) and median age at diagnosis was 9.5yrs (range 0.66-21). Median delay to diagnosis was 12.65 months (range 0.2-144) and median duration of follow up was 25 months (range 6-108)
Outcome: 31.86% had inactive disease, 27.7% were in CRM and 6.7% patients were in CROM at median follow up of 25 months. 33.7% patients had AD. Subcategories: 78.4% of OJIA,70% of UJIA, 69%SJIA, 66% ERA, 62% PJIA, 43% seropositive JIA and 33% of PsJIA had no disease activity (all states of ID, CRM, CROM)
Factors affecting outcome:
Number of active joints at onset: Patients with AD had a median of 4 active joints at onset v/s patients with ID who had a median of 3 active joints (p=0.007).
Delay to diagnosis: Patients with AD at outcome had a median delay to diagnosis of 6 months v/s patients with ID who had a median delay of 4 months (p=0.002).
CHAQ: 76% patients had no disability,17% mild, 5% moderate whereas 3% had severe disability (3).
Management: Patients were managed with NSAIDs, bridging steroids, IAS and DMARDs as appropriate. Only 24% had received BRMs.
Conclusions 66% of patients with JIA had no discernable disease activity at a median follow up of two years,comparable to the outcome data of the Candian inception cohort, where 50% of patients had no disease activity at 6 month follow up (4). A median of 4 active joints at onset and a median delay to diagnosis of 6 months adversely affected the outcome.Of our cohort, 93% of patients had no or mild disability.These outcomes were achieved with a treat to target philosophy where more than75% of patients did not receive a BRM. It is thus possible for children with JIA in the developing world also to have outcomes comparable with western children
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Oen K, Duffy CM, Tse SM, Ramsey S, Ellsworth J, Chédeville G et al. Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort.Arthritis Care Res (Hoboken). 2010 Apr;62(4):527-536
Disclosure of Interest None Declared