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AB0970 Improvement of the Long-Term Outcome in Greek Adult Patients with Juvenile Idiopathic Arthritis in the 21St Century
  1. D. Dimopoulou1,
  2. M. Trachana2,
  3. P. Pratsidou-Gertsi2,
  4. P. Sidiropoulos3,
  5. A. Theodoridou1,
  6. F. Kanakoudi2,
  7. A. Garyfallos1
  1. 14th Department of Internal Medicine
  2. 21st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki
  3. 3Department of Rheumatology, University of Heraklion Crete, Heraklion, Greece

Abstract

Background During the last decade there is evidence of a rising improvement regarding the long-term outcome of patients with Juvenile Idiopathic Arthritis (JIA).

Objectives To compare long-term outcome between patients with disease onset before and after 2000.

Methods Patients (pts) ≥18 years with an established JIA, a disease onset ≥5 years and no history of >6 months care from external rheumatologists, were enrolled in the study. Clinical, laboratory and radiographic examination were performed at the last follow-up visit, 17.2 years post-diagnosis. The outcome variables were: radiographic damage assessed by the total modified Sharp/van der Heijde Score (TmSvdHS), articular and extra-articular damage by Juvenile Arthritis Damage Index (JADI-A and JADI-E) and physical ability by the Health Assessment Questionnaire-Disability Index (HAQ-DI). In the multivariate analysis, possible explanatory variables were characteristics present at onset and active disease duration within 5 years of onset.

Results A total of 102 (72 F) pts were enrolled. The age at disease onset (mean ± SD) was 7.7±4 yrs, the interval from onset to last visit 17.2±6.7 yrs and the pts' current age 25±5.9 yrs. 28 patients were diagnosed after 2000 (Group 1) and 74 patients before 2000 (Group 2). The 2 Groups didn't differ in demographic and clinical characteristics, as gender, type of disease onset and ACPA positivity. At the last follow-up visit, Group 1 had better TmSvdHS, better JADI-A and better JADI-E score as compared to Group 2 (p<0.001, p<0.001, p=0.003, respectively). In contrast, HAQ-DI score did not differ between the 2 Groups (p=0.55) but disease duration within 5 yrs of onset was longer in Group 2 (p=0.02). Prognostic factors for joint damage were disease duration [B (95%CI) 2.114 (0.206,4.022), p=0.03], cumulative % time spent in a state of active disease [B (95%CI) 0.007 (0.004,0.011), p<0.001] and cumulative time spent in a state of clinical remission off medication over the entire disease course [B (95%CI) -0.667 (-1.048,-0.286), p=0.001].

Conclusions Pts diagnosed after 2000, had a better long term outcome as compared to those before 2000. Despite the difference in disease duration, active disease duration within 5 years of onset proved to be a critical prognostic factor, probably reflecting the availability of biologics nowadays and the treat-to-target strategies.

References

  1. Minden K. Adult outcomes of patients with juvenile idiopathic arthritis. Horm Res 2009; 72:20-25.

Disclosure of Interest None declared

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