Background Juvenile Idiopathic Arthritis (JIA) is the most prevalent chronic rheumatic disease in childhood. Disease activity can persist for many years, even through adulthood.
Objectives To evaluate disease activity and health status in a cohort of young adults with JIA.
Methods In order to identify patients with persistent active disease or in Clinical Remission off medication (CR) according to Wallace criteria all young people (over 18 year old), followed in our Transitional Care Clinic, were assessed by clinical examination [including registration of number of joints with swelling, tenderness and limited range of motion (LROM), number of active joints] and laboratory parameters. Physician's global assessment of disease activity measured on a 10 cm VAS, Quality of life according to the Medical Outcome Study 36-item Short Form Health Survey (SF-36), physical disability and discomfort by the Health Assessment Questionnaire (HAQ) were also recorded.
Results 335 consecutive JIA pts (F 237) were evaluated: 39 (11.6%) systemic arthritis, 117 (34.9%) persistent oligoarticular, 48 (14.3%) extended oligoarticular, 80 (23.8%) polyarticular JIA (21 were RF positive), 37 ERA (11%), 14 psoriasic JIA (4.1%). Median age at disease onset was 7.0 yrs (mean 7.8, range 0.1-16.0). Median disease duration was 21.9 yrs (mean 22.7, range 7-51). 237/335 pts were on antirheumatic medication: 134 with biological therapy (BT), 167 with one or more DMARDs and 125 with NSAIDs. Out of the 134 treated with BT 90 were also treated with one or more DMARDs. 98 pts were off medication: 66 of them (67.3%) were inactive and 73 had physician's VAS <1 cm. In total 40.2% (135/335) presented active joints, ranging from 48.6% (12/39) systemic JIA to 28.5% (4/14) psoriasic JIA. All 335 pts received also SF-36 physical score (median 56, mean 62, range 1-99) and SF-36 mental score (median 61, mean 623, range 12-100). In total 149 pts (44.4%) had a pathological HAQ ranging from 69.2% of systemic onset JIA (median 0.625, mean 0.8, range 0-3) to 29% of persistent oligoarticular JIA (median 0.0, mean 0.2, range 0-1.6).
Conclusions Our results support that a substantial proportion of the young adults with JIA had an active disease or was on CRM (still needing antirheumatic therapy) and patient-reported health status was not completely satisfactory in a significant number of them. These results suggest that JIA is not a self-limiting disease and therefore ideally all young pts should be followed by both pediatric and adult rheumatology as a part of a transitional care program.
Selvaag AM, et al. Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis 2014;0:1-6.
Disclosure of Interest None declared