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FRI0492 СLINICAL AND LABORATORY DATA AND ALGORITHM OF MANAGEMENT OF ADULT PATIENTS WITH OLIGO-ARTICULAR VARIANTS OF JIA
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  1. M. Dzhus1,
  2. M. Kyluk1,
  3. O. Ivashkivsky2,
  4. T. Karasevska1
  1. 1O. Bohomolets National Medical University, Internal Medicine 2, Kyiv, Ukraine
  2. 2Oleksandrivsky Clinical Hospital, Rheumatology 1, Kyiv, Ukraine

Abstract

Background: The oligo-articular JIA is a disease that begins in childhood and can lead to joint damage and disability in adulthood with significant social losses.

Objectives: The aim of this study was to evaluate the clinical and laboratory status and to develop an algorithm of managment adult patients with oligo articular variant of JIA, depending on the detection of RF or/and A-CCP, ANA, HLA-B27.

Methods: The study included 168 adult patients from different regions of Ukraine who were diagnosed with JIA in childhood between 1984 and 2014 without severe comorbidities. Inclusion criteria were: age 16 to 60 years; duration of the disease > 3 years. Among patients with JIA were identified 64 patients with oligo-articular variant: 44 (26,2%) - with persistant oligo-arthritis, and 20 (11,9%) with extended oligo-arthritis. The disease activity was evaluated by DAS28 and JADAS-10. The questionaries SF-36, HAQ, TAS-20, PHQ-9 were analyzed and remote articular JADI-A and extra-articular JADI-E damages were evaluated. Statistical studies were performed using IBM SPPS Statistics version 25.0.0.0 software, the results were considered to be reliable at 5% critical level (P <0.05). The distribution of quantitative variables was tested by the Shapiro-Wilk test. Quantitative variables with a normal distribution were expressed as mean ± SD, quantitative variables that showed a non-normal distribution were expressed with a median (P25-P75), also performed correlative analysis of the variables

Results: It was found that patients with active JIA in 26.5% have depression according to the PHQ-9, while patients in remission have no signs of depression. Most adult patients with JIA (86.4%) have elevated and high levels of alexithymia. The predictors of JIA remission in adulthood are male sex (OR = 0.453; 95% CI 0.253-3.556); arthritis of more than 3 joints (OR = 0.459; 95% CI 0.347-0.770); wrist arthritis in childhood (OR = 0.082; 95% CI 0.009-0.739) and JADAS-10 in the disease onset (OR = 0.758; 95% CI 0.589-0.896) <6 points, treatment with IB in the history (OR = 0,767; 95% CI 0.054-0.811) and the duration of DMARDS treatment (OR = 0.741; 95% CI 0.636-0.863) > 1.5 years. The negative correlation of JADI-A and the patient’s physical well-being PCS (r = -0.27, p <0.05) and physical functioning (r = -0.24, p < 0.05), pain intensity (r = -0.24, p <0.05), general health (r = -0.24, p <0.05), vital activity (r = -0,19, p <0,05), social functioning (r = -0,27, p <0,05), mental health (r = -0,22, p <0,05) according to SF-36. The severity of extra-articular damages JADI-E correlated with PCS (r = -0.22, p <0.05) and physical functioning (r = -0.28, p<0.05), pain intensity (r = -0.20, p <0.05), general health (r = -0.23, p <0.05), and mental health (r = -0.23, p <0.05), but also had a positive correlation with HAM-A (r = 0.25, p <0.05), depression scale (r = 0.28, p <0.05) and PHQ-9 (r = 0.28, p <0.05). Significantly lower level of physical health was established in patients who requires prosthetics (p <0.001) compared to those who did not need prosthetics.

Conclusion: Based on the obtained results, algorithms of management of adult patients with JIA oligoarthritis were developed, depending on the detected articular and extra-articular damages and the need for prosthetics and the psychological status.

Disclosure of Interests: None declared

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