Background Dedicated and comprehensive Pediatric Rheumatology (PR) Clinical Programs were recently established in 4 out of 11 countries in Southeast Asia. Little is known about rheumatic diseases in the region, making research difficult. A dedicated REgistry for Childhood Onset Rheumatic Diseases (RECORD) was established in 2009, at KK Women’s and Children’s Hospital, the only freestanding children’s hospital in Singapore.
Objectives To describe and compare the regional characteristics of Juvenile Idiopathic Arthritis (JIA) from a PR cohort in Singapore.
Methods All patients referred for PR evaluation and diagnosed with JIA were recruited from 01/2009 till 12/2012. Demographic and disease characteristic information were collected and median, interquartile range (IQR) & percentiles were used to describe the data.
Results A total of 1,374 patients were referred over the past 48 months, of which 177(12.9%) were diagnosed with JIA according to International League of Associations for Rheumatology (ILAR) criteria. Previously, we noted 58% of referrals were for rheumatologic disease. JIA was the 2nd most common diagnosis after systemic vasculitidies. The racial composition of patients seen were; Chinese 66.1%, Indian 10.7%, Malay 7.9% & Mixed Race 2.8%, reflecting the expected distribution in Singapore. 12.5% of those seen were non-residents from nearby countries. There were 39% females & 61% males. The median age at disease onset was 8.5 years (IQR 5.19-11.86) and median lag time to diagnosis was 2.7 months (IQR 9.5-16.0). Age by JIA subtype is defined in Table 1. Across the entire JIA cohort, Oligoarticular Persistent (OpJIA) 35% and Enthesitis Related JIA (ERA) 33% were the most common subtypes (Table 1). OpJIA patients had almost equal males as females affected while extended oligoarticular disease had 2 times more females. The majority of ERA patients were positive for HLA B27 (75.9%). ANA positivity ranged from 28.6–40% across subtypes excluding ERA 15.2% & PsA 75%. Uveitis was only observed in 8 cases (6.9%) of patients.
Conclusions JIA patients in Singapore differ from other countries in that males were diagnosed with JIA almost 2 times more than in females. This is likely a reflection of the increased number of ERA patients and HLA B27 positivity seen in Asians. Additionally, we had a lower incidence of Systemic JIA and Polyarticular RF negative JIA, similar to other published data on Asian children. ANA positivity was seen in all subtypes at a similar rate other than ERA and PsA. Uveitis was rarely encountered.
References Tan JHT, Hoh SF, Arkachaisri T et al.: Paediatrics Rheumatology Clinic Population in Singapore: The KKH Experience. Proceedings of Singapore Healthcare Volume 21 Number 4 2012
Shen CC, Yeh KW, Ou LS et al.: Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria. J Microbiol Immunol Infect. 2012 Jun 21. pii: S1684-1182(12)00044-8.
Disclosure of Interest None Declared
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