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Cytokine profiling at disease onset: support for classification of young antinuclear antibody-positive patients as a separate category of juvenile idiopathic arthritis
  1. Theo van den Broek1,
  2. Esther Hoppenreijs2,3,
  3. Jenny Meerding1,
  4. Rianne Scholman1,
  5. Henny G Otten4,
  6. Joost F Swart1,
  7. Alberto Martini5,
  8. Berent Prakken1,
  9. Wilco de Jager1
  1. 1Laboratory of Translational Immunology, Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Sint Maartenskliniek, Pediatric Rheumatology, Nijmegen, The Netherlands
  3. 3Radboud University Medical Center, Pediatric Rheumatology, Nijmegen, The Netherlands
  4. 4Laboratory of Translational Immunology, University Medical Center Utrecht, The Netherlands
  5. 5Department of Pediatrics, Gaslini Institute University of Genova, Genova, Italy
  1. Correspondence to Dr Wilco de Jager, Laboratory of Translational Immunology, Department of Pediatric Immunology, University Medical Center Utrecht (UMCU), KB02.085.0, PO Box 85500, Utrecht 3508 GA, The Netherlands; wjager{at}umcutrecht.nl

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The current classification for juvenile idiopathic arthritis (JIA) separates the disease entity JIA into seven disease categories based on clinical and laboratory features1 It is postulated that the combination of early onset of disease and antinuclear antibody (ANA) positivity better classifies a homogeneous subset of patients than the current International League of Associations for Rheumatology (ILAR) categories, displaying asymmetric arthritis, female predominance and an increased risk of developing iridocyclitis.2–5 The classification by the number of joints involved might not be an adequate criterion for identifying homogeneous disease entities. We sought out to determine if this homogenous group of young ANA-positive patients could be distinguished from other JIA patients based on their soluble inflammatory profile. These profiles could aid in the differentiation of patient groups by identifying similar underlying inflammatory processes.

This study prospectively followed 40 patients with JIA at onset of disease at their first visit to the paediatric rheumatology clinic for oligoarthritis (n=24) and rheumatoid factor-negative polyarthritis (n=16). Ethics approval was given by the regional review boards. Informed consent was obtained from all patients. The occurrence of iridocylitis was determined by reviewing total clinical history; the time of follow-up did not differ between the groups analysed (table 1). Apart from nonsteroidal anti-inflammatory drugs (NSAID) therapy, …

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