Background The outcomes of children with juvenile idiopathic arthritis (JIA) have improved over the last decades. Numerous studies reported traditional clinical predictors like pain and functional status for a better outome of JIA. However, a considerable proportion of variance remains unexplained by traditional clinical factors. Considering different issues of psychosocial factors and the subjective burden of illness may improve the prediction and understanding of JIA outcomes.
Objectives To determine the predictive value of clinical and nonmedical factors for inactive disease and health-related quality of life (HrQoL) in a prospective observational cohort study of patients with recent-onset of JIA.
Methods We investigated inactive disease and HrQoL at the 12-month-follow-up in 162 children with early JIA (disease duration of less than 6 months) who have been included in the Inception Cohort Of Newly-diagnosed patients with JIA (ICON). Inactive disease was defined by the clinicians´ rating of disease activity on a numeric rating scale (NRS<1) and HrQoL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales administered to the parents. Traditional clinical predictor variables at study inclusion comprised the number of active and painful joints, ESR, CRP, functional status (CHAQ), pain (21-point NRS), ANA- and HLA-B27-positivity. Additionally, the parent’s educational background and standardised assessments (Strength and Difficulties Questionnaire [SDQ], Childrens´ and Parents´ Arthritis Self-Efficacy scales [CASE, PASE], Family impact questionnaire [FaBel]) were included as nonmedical factors for outcome. Childrens behavioral problems were assessed by the SDQ. The CASE and PASE measured the childrens´ and parents´ ability to control and manage aspects of JIA, the FaBel showed the burden of JIA on family life.
Results Data of 162 patients (67% females) with a mean age of 6 years were considered in the analyses. More than half of the children (56%) were diagnosed with oligoarthrits and 25% with polyarthritis. A total of 87 (54%) children had an inactive disease at the follow-up. Mean HrQoL was 69.1 at baseline, and improved to 85.1 at follow-up. Univariate significant predictors for an inactive disease at the follow-up were the number of active joints, ESR, pain, functional status, educational background of parents and financial burden. A lower number of swollen joints and a higher educational background were found to be significant predictors for inactive disease. HrQoL at follow-up was associated with the number of active joints, pain, functional status, childrens´ behavioral problems, childrens´ ability to control and manage the disease, and family problems at baseline. Children with a tendency to hyperactivity, with problems in social relationships, and a high level of pain reported lower HrQoL.
Conclusions Nowadays, approximately one in two patients with JIA attains inactive disease within 12 months of specialised care. The 12-month-outcome is determined not only by traditional clinical parameters, but to a substantial part also by individual and family factors. Those have to be additionally considered in the treatment of JIA patients.
Acknowledgements Supportedbyby a grant from the Federal Ministry of Education and Research (FKZ 01ER0812).
Disclosure of Interest M. Niewerth: None Declared, J. Klotsche: None Declared, I. Liedmann: None Declared, G. Horneff Grant/research support from: Pfizer, AbbVie, Roche, D. Foell: None Declared, J.-P. Haas: None Declared, K. Minden Grant/research support from: Pfizer, AbbVie
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