Evaluation of clinical and radiological findings in children with juvenile idiopathic arthritis

Abstract

Aim: Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatologic condition in children. Determining radiological progression in relation to clinical and laboratory parameters is crucial for initiating early intervention. This study aimed to investigate the association between diagnostic delay, human leukocyte antigen B27 (HLA-B27) positivity, and the development of late radiological changes in children with JIA. Methods: This retrospective single-center study included 96 patients diagnosed with JIA between January 2006 and April 2015. Demographic, clinical, laboratory, and radiological data were reviewed. Radiological changes emerging after one year of disease onset were defined as late radiological findings. Clinical features, laboratory markers, and treatment modalities were compared between patients with early and late radiological changes. Results: The mean age at diagnosis was 8.8 ± 4.0 years; 67.7% were female. Oligoarticular JIA was the most common subtype, occurring in 67 patients (69.8%), followed by systemic JIA in 20 patients (20.8%) and polyarticular JIA in 9 patients (9.4%). Late radiological changes were observed in 35 patients (36.5%). HLA-B27 positivity (20.0% vs. 6.6%, p=0.049), longer diagnostic delay (3.3 ± 2.0 vs 2.0 ± 1.8 years, p=0.002), higher joint involvement (5.6 ± 3.6 vs. 4.2 ± 2.7, p=0.033), and extra-articular findings (68.6% vs. 27.9%, p=0.001) were associated with late radiological changes. Antinuclear antibody (ANA) test positivity was inversely associated (40.0% vs. 62.3%, p=0.034). Conclusions: HLA-B27 positivity and diagnostic delay were associated with late radiological changes in children with JIA. Early diagnosis and close radiological monitoring may help prevent long-term joint damage.

Keywords

• Juvenile idiopathic arthritis
• HLA-B27 antigen
• diagnostic delay
• radiological progression
• pediatric rheumatology

Çocuklarda juvenil idiyopatik artritte klinik ve radyolojik özelliklerin değerlendirilmesi

Abstract

Amaç: Juvenil idiyopatik artrit (JİA), çocuklarda en sık görülen kronik romatolojik hastalıktır. Klinik ve laboratuvar parametreleri ile ilişkili radyolojik ilerlemenin belirlenmesi, erken müdahalenin başlatılması için çok önemlidir. Bu çalışmanın amacı, JİA’lı çocuklarda tanı gecikmesi, insan lökosit antijeni B27 (HLA-B27) pozitifliği ile geç dönem radyolojik değişikliklerin gelişimi arasındaki ilişkinin araştırılmasıdır. Yöntem: Bu retrospektif tek merkezli çalışma, Ocak 2006 ile Nisan 2015 tarihleri arasında JIA tanısı konulan 96 hasta dahil edildi. Demografik, klinik, laboratuvar ve radyolojik veriler incelenmiştir. Hastalığın başlangıcından bir yıl sonra ortaya çıkan radyografik değişiklikler “geç dönem radyolojik bulgular” olarak tanımlanmıştır. Erken ve geç radyolojik değişiklikleri olan hastalar klinik özellikler, laboratuvar belirteçleri ve tedavi yöntemleri açısından karşılaştırılmıştır. Bulgular: Tanı anındaki ortalama yaş 8,8 ± 4,0 yıl olup, hastaların %67,7’si kızdı. En yaygın alt tip oligoartiküler JIA olup 67 hastada (%69,8) görülmüştür, bunu 20 hastada (%20,8) sistemik JIA ve 9 hastada (%9,4) poliartiküler JIA izlemiştir. Geç radyolojik değişiklikler 35 hastada (%36,5) saptandı. HLA-B27 pozitifliği (%20’e karşı %6,6; p=0,048), daha uzun tanı gecikmesi (3.3 ± 2.0 karşı 2.0 ± 1.8 yıl; p=0,002), daha yüksek eklem tutulumu (5,6 ± 3,6’ya karşı 4,2 ± 2,7; p=0,032) ve ekstraartiküler bulguların varlığı (%68,6’ya karşı %27,9; p=0,001) geç radyolojik değişiklikler ile ilişkiliydi. Antinuclear antibody (ANA) test pozitifliği ise ters yönde ilişkili bulundu (%40’a karşı %62.3; p=0,034). Sonuç: HLA-B27 pozitifliği ve tanı gecikmesi, JİA’lı çocuklarda geç dönem radyolojik değişikliklerle ile ilişkilidir. Erken tanı ve düzenli radyolojik izlem, uzun dönem eklem hasarının önlenmesine katkı sağlayabilir.

Keywords

• Juvenil idiyopatik artrit
• HLA-B27 antijeni
• Tanı gecikmesi
• Radyolojik progresyon
• Pediatrik romatoloji.

References

1. Giancane G, Consolaro A, Lanni S, Davi S, Schiappapietra B, and Ravelli A. Juvenile Idiopathic Arthritis: Diagnosis and Treatment. Rheumatol Ther. 2016;3(2):187-207. DOI: 10.1007/s40744-016-0040-4.
2. Mistry RR, Patro P, Agarwal V, and Misra DP. Enthesitis-related arthritis: current perspectives. Open Access Rheumatol. 2019;11:19-31. DOI: 10.2147/OARRR.S163677.
3. Macaubas C, Nguyen K, Milojevic D, Park JL, and Mellins ED. Oligoarticular and polyarticular JIA: epidemiology and pathogenesis. Nat Rev Rheumatol. 2009;5(11):616-26. DOI: 10.1038/nrrheum.2009.209.
4. Sheybani EF, Khanna G, White AJ, and Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics. 2013;33(5):1253-73. DOI: 10.1148/rg.335125178.
5. Hemke R, Herregods N, Jaremko JL, et al. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol. 2020;30(10):5237-49. DOI: 10.1007/s00330-020-06807-8.
6. Garner AJ, Saatchi R, Ward O, and Hawley DP. Juvenile Idiopathic Arthritis: A Review of Novel Diagnostic and Monitoring Technologies. Healthcare (Basel). 2021;9(12) DOI: 10.3390/healthcare9121683.
7. Saurenmann RK, Levin AV, Feldman BM, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum. 2007;56(2):647-57. DOI: 10.1002/art.22381.
8. Beesley RP, Kearsley-Fleet L, Baildam E, et al. The association between ethnicity, socioeconomic position and outcomes following initiation of methotrexate in juvenile idiopathic arthritis. EULAR Rheumatology Open. 2025;1(4):372-79.

9. Al-Mayouf SM, Al Mutairi M, Bouayed K, et al. Epidemiology and demographics of juvenile idiopathic arthritis in Africa and Middle East. Pediatr Rheumatol Online J. 2021;19(1):166. DOI: 10.1186/s12969-021-00650-x.
10. Verstappen SM, Cobb J, Foster HE, et al. The association between low socioeconomic status with high physical limitations and low illness self-perception in patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study. Arthritis Care Res (Hoboken). 2015;67(3):382-9. DOI: 10.1002/acr.22466.
11. Lee YS, Gor K, Sprong ME, Shrestha J, Huang X, and Hollender H. Development of a machine learning-based predictive nomogram for screening children with juvenile idiopathic arthritis: a pseudo-longitudinal study of 223,195 children in the United States. Front Public Health. 2025;13:1531764. DOI: 10.3389/fpubh.2025.1531764.
12. Peltoniemi SOO, Glerup M, Lahdenne P, Eklund KK, and Aalto K. Disease characteristics of HLA-B27 positive and negative finnish patients with juvenile idiopathic arthritis - results of the 18-year cohort follow-up study. Pediatr Rheumatol Online J. 2023;21(1):94. DOI: 10.1186/s12969-023-00878-9.
13. Weiss PF, Arabshahi B, Johnson A, et al. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Arthritis Rheum. 2008;58(4):1189-96. DOI: 10.1002/art.23401.
14. Tay SH, Yeo JG, Leong JY, Albani S, and Arkachaisri T. Juvenile Spondyloarthritis: What More Do We Know About HLA-B27, Enthesitis, and New Bone Formation? Front Med (Lausanne). 2021;8:666772. DOI: 10.3389/fmed.2021.666772.
15. Yamaguchi A, Tsuchiya N, Mitsui H, et al. Association of HLA-B39 with HLA-B27-negative ankylosing spondylitis and pauciarticular juvenile rheumatoid arthritis in Japanese patients. Evidence for a role of the peptide-anchoring B pocket. Arthritis Rheum. 1995;38(11):1672-7. DOI: 10.1002/art.1780381120.
16. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390-2.
17. Ording Muller LS, Humphries P, and Rosendahl K. The joints in juvenile idiopathic arthritis. Insights Imaging. 2015;6(3):275-84. DOI: 10.1007/s13244-015-0406-0.
18. Costello A, Rasooly I, and Weiss P. Rheum for Improvement? Delayed Diagnosis of Juvenile Idiopathic Arthritis: A Narrative Review. Arthritis Care Res (Hoboken). 2025;77(3):283-90. DOI: 10.1002/acr.25438.
19. Zajc Avramovic M, Toplak N, Markelj G, Emersic N, and Avcin T. Long-term follow-up of 109 children with juvenile idiopathic oligoarthritis after first intra-articular corticosteroid injection. Arthritis Res Ther. 2024;26(1):69. DOI: 10.1186/s13075-024-03303-y.
20. Hersh AO and Prahalad S. Immunogenetics of juvenile idiopathic arthritis: A comprehensive review. J Autoimmun. 2015;64:113-24. DOI: 10.1016/j.jaut.2015.08.002.
21. Glerup M, Rypdal V, Arnstad ED, et al. Long-Term Outcomes in Juvenile Idiopathic Arthritis: Eighteen Years of Follow-Up in the Population-Based Nordic Juvenile Idiopathic Arthritis Cohort. Arthritis Care Res (Hoboken). 2020;72(4):507-16. DOI: 10.1002/acr.23853.
22. Balmuri N, Soulsby WD, Cooley V, et al. Community poverty level influences time to first pediatric rheumatology appointment in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J. 2021;19(1):122. DOI: 10.1186/s12969-021-00610-5.
23. Foster HE, Eltringham MS, Kay LJ, Friswell M, Abinun M, and Myers A. Delay in access to appropriate care for children presenting with musculoskeletal symptoms and ultimately diagnosed with juvenile idiopathic arthritis. Arthritis Rheum. 2007;57(6):921-7. DOI: 10.1002/art.22882.
24. Hamdi W, Ferjani H, Carlomagno R, et al. Factors associated with poor prognosis of hip arthritis in juvenile idiopathic arthritis: Data from the JIR cohort. Musculoskeletal Care. 2023;21(3):806-14. DOI: 10.1002/msc.1755.
25. Oliveira Ramos F, Zinterl C, and Fonseca JE. A lifelong journey: Long-term perspectives on Juvenile Idiopathic Arthritis. Best Pract Res Clin Rheumatol. 2024;38(3):101984. DOI: 10.1016/j.berh.2024.101984.
26. Aoust L, Rossi-Semerano L, Kone-Paut I, and Dusser P. Time to diagnosis in juvenile idiopathic arthritis: a french perspective. Orphanet J Rare Dis. 2017;12(1):43. DOI: 10.1186/s13023-017-0586-4.
27. Min M, Hancock DG, Aromataris E, Crotti T, and Boros C. Experiences of living with juvenile idiopathic arthritis: a qualitative systematic review. JBI Evid Synth. 2022;20(1):60-120.
28. Soulsby WD, Balmuri N, Cooley V, et al. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J. 2022;20(1):18.
29. Lazar C, Crisan M, Man OI, Sur LM, Samasca G, and Bolundut AC. Juvenile Spondyloarthropathies: Diagnostic and Therapeutic Advances-A Narrative Review. J Clin Med. 2025;14(9).
30. Berntson L, Nordal E, Aalto K, et al. HLA-B27 predicts a more chronic disease course in an 8-year followup cohort of patients with juvenile idiopathic arthritis. J Rheumatol. 2013;40(5):725-31.
31. Flato B, Smerdel A, Johnston V, et al. The influence of patient characteristics, disease variables, and HLA alleles on the development of radiographically evident sacroiliitis in juvenile idiopathic arthritis. Arthritis Rheum. 2002;46(4):986-94.
32. Srinivasalu H, Sikora KA, and Colbert RA. Recent Updates in Juvenile Spondyloarthritis. Rheum Dis Clin North Am. 2021;47(4):565-83.
33. Kljucevsek D, Potocnik Tumpaj V, and Gazikalovic A. The role of radiography in diagnosing, monitoring and prognosing juvenile idiopathic arthritis. Pediatr Radiol. 2024;54(4):481-89.
34. Costello R, McDonagh J, Hyrich KL, and Humphreys JH. Incidence and prevalence of juvenile idiopathic arthritis in the United Kingdom, 2000-2018: results from the Clinical Practice Research Datalink. Rheumatology (Oxford). 2022;61(6):2548-54.
35. Munir S, Patil K, Miller E, et al. Juvenile idiopathic arthritis of the axial joints: a systematic review of the diagnostic accuracy and predictive value of conventional MRI. AJR Am J Roentgenol. 2014;202(1):199-210.
36. Rygg M, Ramos FO, and Nordal EB. What have we learned from long-term studies in juvenile idiopathic arthritis? - Prediction, classification, transition. Pediatr Rheumatol Online J. 2025;23(1):18.
37. Thiele F, Klein A, Klotsche J, et al. Biologics with or without methotrexate in treatment of polyarticular juvenile idiopathic arthritis: effectiveness, safety and drug survival. Rheumatology (Oxford). 2023;62(6):2230-38.
38. Ferrara G, Mastrangelo G, Barone P, et al. Methotrexate in juvenile idiopathic arthritis: advice and recommendations from the MARAJIA expert consensus meeting. Pediatr Rheumatol Online J. 2018;16(1):46.
39. Ruth NM and Passo MH. Juvenile idiopathic arthritis: management and therapeutic options. Ther Adv Musculoskelet Dis. 2012;4(2):99-110.