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Sistemik Juvenil İdiyopatik Artritte Son On Yılda Neler Değişti?

Year 2021, Volume 15, Issue 1, 65 - 71, 22.01.2021
https://doi.org/10.12956/tchd.807572

Abstract

Amaç: Sistemik juvenil idiyopatik artrit (sJİA), JİA’nın yedi alt tipinden biridir. Bu çalışmanın amacı, kliniğimizdeki sJİA hastalarının özelliklerini, seyrini ve sonuçlarını araştırmak ve son on yılda sJİA’da nelerin değiştiğini belirlemektir.

Gereç ve Yöntemler: Mart 2002 ile Nisan 2019 arasında takip edilen sJİA hastalarının dosyaları geriye dönük olarak değerlendirildi ve verileri kaydedildi.

Bulgular: Çalışma süresince kliniğimizde 36 hastaya sJİA tanısı konuldu (19 erkek). Hastalığın başlangıcında hastaların ortalama yaşı 81.7±50.1 aydı. Başvuru esnasında en sık saptanan bulgular ateş (%100), artrit (%83.3), döküntü (% 66.7) ve hepatosplenomegali (%38.9)’du. Yedi hasta (%19.4) sJİA’ya bağlı gelişen makrofaj aktivasyon sendromu (MAS) tanısı aldı. Tüm hastalara kortikosteroid tedavisi verildi. 29 hastaya ek tedaviler (hastalığı modifiye edici ilaçlar, intravenöz immünoglobulin ve biyolojik ajanlar) verildi. Kliniğimizde 2011 yılından itibaren anti interlökin (İL) -1 ajanlar kullanılmaktadır. Bu grupta 26 (%72.2) hasta 2011 yılından sonra tanı almıştır. 2011 yılından sonra tanı alan ve biyolojik ajan tedavisi kullanılan hastalarda (n: 26) 2011 yılından önce tanı alan hastalara (n:10) göre steroid maruziyet süresi anlamlı olarak kısalmıştır (p = 0.001 ).

Sonuç: Biyolojik ajanların sJİA tedavisinde kullanılmaya başlamasından sonra steroid maruziyet süresi önemli ölçüde azalmıştır. Anti İL-1 ve anti İL-6 tedavilerinin sJİA hastalarında öncelikli tedaviler arasında düşünülmesi hem hızlı hastalık kontrolünü sağlamak hem de ilaçlara bağlı ortaya çıkabilecek yan etkileri azaltmak açısından önemlidir.

References

  • Reference 1. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369(9563): 767-78. doi: 10.1016/S0140-6736(07)60363-8
  • Reference2. Giancane G, Consolaro A, Lanni S, Davì S, Schiappapietra B, et al. Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatology and Therapy 2016; 3(2): 187‐207. doi: 10.1007/s40744-016-0040-4
  • Reference3. Cassidy JT, Levinson JE, Bass JC, Baum J, Brewer EJ, et al. A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis and Rheumtology 1986; 29(2): 274‐281. doi: 10.1002/art.1780290216
  • Reference4. Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. Journal of Rheumatology 1998; 25(10): 1991‐1994.
  • Reference5. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. Journal of Rheumatology 2004; 31(2): 390‐392.
  • Reference6. Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. Journal of Rheumatology 2019; 46(2): 190‐197. doi:10.3899/jrheum.180168
  • Reference7. Cimaz R. Systemic-onset juvenile idiopathic arthritis. Autoimmunity Reviews 2016; 15(9): 931‐934. doi: 10.1016/j.autrev.2016.07.004
  • Reference8. Mellins ED, Macaubas C, Grom AA. Pathogenesis of systemic juvenile idiopathic arthritis: some answers, more questions. Nature Reviews Rheumatology 2011; 7(7): 416‐426. doi: 10.1038/nrrheum.2011.68
  • Reference9. Martini A. Systemic juvenile idiopathic arthritis. Autoimmunity Reviews 2012; 12(1): 56‐59. doi:10.1016/j.autrev.2012.07.022
  • Reference10. Dueckers G, Guellac N, Arbogast M, Foeldvari I, Frosch M, et al. Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis. Clinical Immunology 2012; 142(2): 176‐193. doi: 10.1016/j.clim.2011.10.003
  • Reference11. Timothy Beukelman . Treatment advances in systemic juvenile idiopathic arthritis. F1000Prime Reports 2014; 6: 21. doi:10.12703/P6-21
  • Reference12. Ravelli A, Minoia F, Davi S, Horne A, Bovis F, et al. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatology 2016;68:566-76. doi: 10.1002/art.39332
  • Reference13. Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheumatology 2005; 52: 3554-62. doi: 10.1002/art.21389
  • Reference14. Bruck N, Schnabel A, Hedrich CM. Current understanding of the pathophysiology of systemic juvenile idiopathic arthritis (sJIA) and target-directed therapeutic approaches. Clinical Immunology 2015; 159(1): 72‐83. doi: 10.1016/j.clim.2015.04.018
  • Reference15. Kumar S. Systemic Juvenile Idiopathic Arthritis: Diagnosis and Management. Indian Journal of Pediatrics 2016;83(4):322-7. doi:10.1007/s12098-016-2060-z
  • Reference16. Barut K, Adrovic A, Sahin S, Tarcin G, Tahaoglu G, et al. Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single-center experience. International Journal of Rheumatic Diseases 2019;22(9):1661-1669. doi:10.1111/1756-185X.13649
  • Reference17. Çakan M, Karadağ ŞG, Tanatar A, Ayaz NA. The frequency of macrophage activation syndrome and disease course in systemic juvenile idiopathic arthritis. Modern Rheumatology 2019;1-5. doi: 10.1080/14397595.2019.1660026.
  • Reference18. Davi S, Minoia F, Pistorio A, Horne A, Consolaro A, et al. Performance of Current Guidelines for Diagnosis of Macrophage Activaton Syndrome Complicating Systemic Juvenil Idiopathic Arthritis. Arthritis Rheumatology 2014; 66(10): 2871‐2880. doi:10.1002/art.38769
  • Reference19. Ringold S, Weiss PF, Beukelman T, DeWitt EM, Ilowite N, et al.; American Collge of Rheumatology. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis and Rheumatology 2013; 65(10): 2499‐2512. doi: 10.1002/art.38092
  • Reference20. Russo RA, Katsicas MM. Clinical remission in patients with systemic juvenile idiopathic arthritis treated with anti-tumor necrosis factor agents. Journal of Rheumatology 2009; 36: 1078-82. doi:10.3899/jrheum.090952
  • Reference21. De Benetti F, Brunner HI, Ruperto N, Kenwright A, Wright S, et al. Randomized trial of Tocilizumab in Systemic Juvenile Idiopathic Arthritis. New England Journal of Medicine 2012; 367(25): 2385-2395. doi:10.1056/NEJMoa1112802
  • Reference22. Horneff G, Schulz AC, Klotsche J, Hospach A, Minden K, et al. Experience with etanercept, tocilizumab and interleukin-1 inhibitors in systemic onset juvenile idiopathic arthritis patients from the BIKER registry. Arthritis Research and Therapy 2017: 22;19(1): 256. doi: 10.1186/s13075-017-1462-2
  • 23. Baris HE, Anderson E, Sozeri B, Dedeoglu F. Impact of biologics on disease course in systemic onset juvenile idiopathic arthritis. Clinical Rheumatology 2018; 37(12): 3263-3273. doi:10.1007/s10067-018-4297-6

What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?

Year 2021, Volume 15, Issue 1, 65 - 71, 22.01.2021
https://doi.org/10.12956/tchd.807572

Abstract

Objective: Systemic juvenile idiopathic arthritis (sJIA) is one of seven subtypes of JIA. The aim of this study was to investigate the characteristics, the course and the outcome of sJIA patients in our clinic and to identify what has changed over the last decade in sJIA.

Material and Methods: Files of sJIA patients that were followed between March 2002 and April 2019 were evaluated.

Results: During the study period 36 patients were diagnosed with sJIA in our clinic (19 were male). Mean age of patients was 81.7±50.1 months at the onset of disease. Most common presenting features were fever (100%), arthritis (83.3%), rash (66.7%) and hepatosplenomegaly (38.9%). Seven patients (19.4%) were diagnosed as macrophage activation syndrome (MAS) due to sJIA. All patients had received corticosteroids. Additional treatments (disease-modifying drugs, intravenous immunoglobulin and biological agents) were given to 29 patients. In our clinic, anti-IL-1 agents have been used since 2011. In this group 26 (72.2%) patients were diagnosed after 2011. After the usage of biological agents, the duration of steroid exposure significantly decreased (p= 0.001).

Conclusion: After the introduction of biological agents in the treatment of sJIA, the duration of steroid exposure decreased significantly. Considering anti interleukin (IL)-1 and anti IL-6 treatments among the priority treatments in sJIA patients is important in terms of both providing rapid disease control and reducing side effects related to drugs.

References

  • Reference 1. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369(9563): 767-78. doi: 10.1016/S0140-6736(07)60363-8
  • Reference2. Giancane G, Consolaro A, Lanni S, Davì S, Schiappapietra B, et al. Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatology and Therapy 2016; 3(2): 187‐207. doi: 10.1007/s40744-016-0040-4
  • Reference3. Cassidy JT, Levinson JE, Bass JC, Baum J, Brewer EJ, et al. A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis and Rheumtology 1986; 29(2): 274‐281. doi: 10.1002/art.1780290216
  • Reference4. Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. Journal of Rheumatology 1998; 25(10): 1991‐1994.
  • Reference5. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. Journal of Rheumatology 2004; 31(2): 390‐392.
  • Reference6. Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. Journal of Rheumatology 2019; 46(2): 190‐197. doi:10.3899/jrheum.180168
  • Reference7. Cimaz R. Systemic-onset juvenile idiopathic arthritis. Autoimmunity Reviews 2016; 15(9): 931‐934. doi: 10.1016/j.autrev.2016.07.004
  • Reference8. Mellins ED, Macaubas C, Grom AA. Pathogenesis of systemic juvenile idiopathic arthritis: some answers, more questions. Nature Reviews Rheumatology 2011; 7(7): 416‐426. doi: 10.1038/nrrheum.2011.68
  • Reference9. Martini A. Systemic juvenile idiopathic arthritis. Autoimmunity Reviews 2012; 12(1): 56‐59. doi:10.1016/j.autrev.2012.07.022
  • Reference10. Dueckers G, Guellac N, Arbogast M, Foeldvari I, Frosch M, et al. Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis. Clinical Immunology 2012; 142(2): 176‐193. doi: 10.1016/j.clim.2011.10.003
  • Reference11. Timothy Beukelman . Treatment advances in systemic juvenile idiopathic arthritis. F1000Prime Reports 2014; 6: 21. doi:10.12703/P6-21
  • Reference12. Ravelli A, Minoia F, Davi S, Horne A, Bovis F, et al. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatology 2016;68:566-76. doi: 10.1002/art.39332
  • Reference13. Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheumatology 2005; 52: 3554-62. doi: 10.1002/art.21389
  • Reference14. Bruck N, Schnabel A, Hedrich CM. Current understanding of the pathophysiology of systemic juvenile idiopathic arthritis (sJIA) and target-directed therapeutic approaches. Clinical Immunology 2015; 159(1): 72‐83. doi: 10.1016/j.clim.2015.04.018
  • Reference15. Kumar S. Systemic Juvenile Idiopathic Arthritis: Diagnosis and Management. Indian Journal of Pediatrics 2016;83(4):322-7. doi:10.1007/s12098-016-2060-z
  • Reference16. Barut K, Adrovic A, Sahin S, Tarcin G, Tahaoglu G, et al. Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single-center experience. International Journal of Rheumatic Diseases 2019;22(9):1661-1669. doi:10.1111/1756-185X.13649
  • Reference17. Çakan M, Karadağ ŞG, Tanatar A, Ayaz NA. The frequency of macrophage activation syndrome and disease course in systemic juvenile idiopathic arthritis. Modern Rheumatology 2019;1-5. doi: 10.1080/14397595.2019.1660026.
  • Reference18. Davi S, Minoia F, Pistorio A, Horne A, Consolaro A, et al. Performance of Current Guidelines for Diagnosis of Macrophage Activaton Syndrome Complicating Systemic Juvenil Idiopathic Arthritis. Arthritis Rheumatology 2014; 66(10): 2871‐2880. doi:10.1002/art.38769
  • Reference19. Ringold S, Weiss PF, Beukelman T, DeWitt EM, Ilowite N, et al.; American Collge of Rheumatology. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis and Rheumatology 2013; 65(10): 2499‐2512. doi: 10.1002/art.38092
  • Reference20. Russo RA, Katsicas MM. Clinical remission in patients with systemic juvenile idiopathic arthritis treated with anti-tumor necrosis factor agents. Journal of Rheumatology 2009; 36: 1078-82. doi:10.3899/jrheum.090952
  • Reference21. De Benetti F, Brunner HI, Ruperto N, Kenwright A, Wright S, et al. Randomized trial of Tocilizumab in Systemic Juvenile Idiopathic Arthritis. New England Journal of Medicine 2012; 367(25): 2385-2395. doi:10.1056/NEJMoa1112802
  • Reference22. Horneff G, Schulz AC, Klotsche J, Hospach A, Minden K, et al. Experience with etanercept, tocilizumab and interleukin-1 inhibitors in systemic onset juvenile idiopathic arthritis patients from the BIKER registry. Arthritis Research and Therapy 2017: 22;19(1): 256. doi: 10.1186/s13075-017-1462-2
  • 23. Baris HE, Anderson E, Sozeri B, Dedeoglu F. Impact of biologics on disease course in systemic onset juvenile idiopathic arthritis. Clinical Rheumatology 2018; 37(12): 3263-3273. doi:10.1007/s10067-018-4297-6

Details

Primary Language English
Subjects General and Internal Medicine
Journal Section ORIGINAL ARTICLES
Authors

Fatma AYDIN (Primary Author)
Ministry of Health , Ankara City Hospital, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
0000-0003-0306-7473
Türkiye


Tuba KURT
Ministry of Health , Ankara City Hospital, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
0000-0003-3711-8347
Türkiye


Nilüfer TEKGÖZ This is me
Ministry of Health , Ankara City Hospital, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
0000-0002-2235-4489
Türkiye


Müge SEZER This is me
Ministry of Health , Ankara City Hospital, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
0000-0002-9254-9935
Türkiye


Özge BAŞARAN
Ministry of Health , Ankara City Hospital, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
0000-0002-8534-0930
Türkiye


Nilgün ÇAKAR
ANKARA UNIVERSITY, ANKARA FACULTY OF MEDICINE
0000-0021-8530-0101
Türkiye


Banu ACAR
Ministry of Health , Ankara City Hospital, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
0000-0002-1808-3655
Türkiye

Publication Date January 22, 2021
Application Date October 8, 2020
Acceptance Date November 24, 2020
Published in Issue Year 2021, Volume 15, Issue 1

Cite

Bibtex @research article { tchd807572, journal = {Türkiye Çocuk Hastalıkları Dergisi}, issn = {1307-4490}, eissn = {2148-3566}, address = {Şehit Ömer Halisdemir Cad. Kurtdereli Sok. No:10 ANKARA}, publisher = {T.C. Sağlık Bakanlığı Ankara Şehir Hastanesi}, year = {2021}, volume = {15}, pages = {65 - 71}, doi = {10.12956/tchd.807572}, title = {What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?}, key = {cite}, author = {Aydın, Fatma and Kurt, Tuba and Tekgöz, Nilüfer and Sezer, Müge and Başaran, Özge and Çakar, Nilgün and Acar, Banu} }
APA Aydın, F. , Kurt, T. , Tekgöz, N. , Sezer, M. , Başaran, Ö. , Çakar, N. & Acar, B. (2021). What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis? . Türkiye Çocuk Hastalıkları Dergisi , 15 (1) , 65-71 . DOI: 10.12956/tchd.807572
MLA Aydın, F. , Kurt, T. , Tekgöz, N. , Sezer, M. , Başaran, Ö. , Çakar, N. , Acar, B. "What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?" . Türkiye Çocuk Hastalıkları Dergisi 15 (2021 ): 65-71 <https://dergipark.org.tr/en/pub/tchd/issue/59876/807572>
Chicago Aydın, F. , Kurt, T. , Tekgöz, N. , Sezer, M. , Başaran, Ö. , Çakar, N. , Acar, B. "What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?". Türkiye Çocuk Hastalıkları Dergisi 15 (2021 ): 65-71
RIS TY - JOUR T1 - What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis? AU - Fatma Aydın , Tuba Kurt , Nilüfer Tekgöz , Müge Sezer , Özge Başaran , Nilgün Çakar , Banu Acar Y1 - 2021 PY - 2021 N1 - doi: 10.12956/tchd.807572 DO - 10.12956/tchd.807572 T2 - Türkiye Çocuk Hastalıkları Dergisi JF - Journal JO - JOR SP - 65 EP - 71 VL - 15 IS - 1 SN - 1307-4490-2148-3566 M3 - doi: 10.12956/tchd.807572 UR - https://doi.org/10.12956/tchd.807572 Y2 - 2020 ER -
EndNote %0 Turkish Journal of Pediatric Disease What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis? %A Fatma Aydın , Tuba Kurt , Nilüfer Tekgöz , Müge Sezer , Özge Başaran , Nilgün Çakar , Banu Acar %T What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis? %D 2021 %J Türkiye Çocuk Hastalıkları Dergisi %P 1307-4490-2148-3566 %V 15 %N 1 %R doi: 10.12956/tchd.807572 %U 10.12956/tchd.807572
ISNAD Aydın, Fatma , Kurt, Tuba , Tekgöz, Nilüfer , Sezer, Müge , Başaran, Özge , Çakar, Nilgün , Acar, Banu . "What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?". Türkiye Çocuk Hastalıkları Dergisi 15 / 1 (January 2021): 65-71 . https://doi.org/10.12956/tchd.807572
AMA Aydın F. , Kurt T. , Tekgöz N. , Sezer M. , Başaran Ö. , Çakar N. , Acar B. What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?. Türkiye Çocuk Hast Derg. 2021; 15(1): 65-71.
Vancouver Aydın F. , Kurt T. , Tekgöz N. , Sezer M. , Başaran Ö. , Çakar N. , Acar B. What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?. Türkiye Çocuk Hastalıkları Dergisi. 2021; 15(1): 65-71.
IEEE F. Aydın , T. Kurt , N. Tekgöz , M. Sezer , Ö. Başaran , N. Çakar and B. Acar , "What Has Changed Over the Last Decade in Systemic Juvenile İdiopathic Arthritis?", Türkiye Çocuk Hastalıkları Dergisi, vol. 15, no. 1, pp. 65-71, Jan. 2021, doi:10.12956/tchd.807572


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