Determining Predictive Factors for Refractory Disease in Oligoarticular Juvenile Idiopathic Arthritis

Öz

Aim: This study aims to compare the clinical and demographic characteristics of patients diagnosed with oligoarticular juvenile idiopathic arthritis (JIA) treated with conventional disease-modifying antirheumatic drugs (cDMARDs) versus those requiring additional biologic DMARDs (bDMARDs). Additionally, it aims to identify the factors that necessitate the inclusion of bDMARDs in the treatment regimen and to determine predictors of long-term treatment resistance. Materials and Methods: Patients diagnosed with oligoarticular JIA were classified into two groups based on their response to cDMARDs: responders and resistant. Results: The study included 71 patients with oligoarticular JIA on DMARDs. Knee joint complaints were most common (83.1%), followed by ankle joint (29.6%). All patients were started on non-steroidal anti-inflammatory drugs (NSAIDs) at diagnosis, and cDMARDs were initiated at a median of one month (IQR: 3 months). The most commonly initiated treatment in these patients was methotrexate (MTX) (97.2%). cDMARDs were effective in 21 patients (29.5%), while 50 patients (70.4%) were resistant to cDMARDs and required the initiation of bDMARDs. In comparing cDMARD-responsive and resistant groups starting bDMARDs, family history was more common in responders (23.6%, p=0.044), while ankle involvement was higher in resistant group (38%, p=0.016). Univariate analysis highlighted ankle/toe joint involvement as a risk factor for resistance (p=0.027, CI 95%), and family history as protective (p=0.043, CI 95%). When multivariate analysis was performed with the variables that were significant in univariate analysis, there was statistical significance only in the involvement of ankle/toe joints (ankle/toe joints OR=5.29 CI 95% (1.08-25.83), p=0.040, family history OR=0.24 CI 95% (0.05-1.19), p=0.080). Conclusion: In patients with oligoarticular JIA, the involvement of ankle/toe joints at diagnosis increases the risk of resistance to cDMARD therapy. Therefore, careful monitoring of these patients is warranted during follow-up.

Anahtar Kelimeler

• Disease-modifying antirheumatic drugs
• oligoarticular juvenile idiopathic arthritis
• predictive factors
• refractory disease

Oligoartiküler Juvenil İdiyopatik Artritte Dirençli Hastalığı Öngörücü Faktörlerin Belirlenmesi

Öz

Amaç: Bu çalışma, oligoartiküler jüvenil idiyopatik artrit (JİA) tanısı almış ve konvansiyonel hastalık modifiye edici antiromatizmal ilaç (kDMARD) tedavisi alan hastalar ile biyolojik DMARD (bDMARD) tedavisine ihtiyaç duyan hastaların klinik ve demografik özelliklerini karşılaştırmayı amaçlamaktadır. Ayrıca, tedavi rejimine bDMARD eklenmeyi gerektiren faktörleri ve uzun vadeli tedavi direncinin öngörücülerini belirlemeyi hedeflemektedir. Gereç ve Yöntem: Oligoartiküler JİA tanısı almış hastalar, kDMARD yanıtlarına göre iki gruba ayrıldı: yanıt verenler ve dirençli olanlar. İki grup arasında klinik ve demografik özellikler karşılaştırıldı. Bulgular: Çalışmaya, DMARD kullanan 71 oligoartiküler JİA hastası dahil edildi. Hastalar en sık diz eklemi (%83.1) ardından ayak bileği eklemi (%29.6) şikayetleri ile başvurdu. Tüm hastalara tanı anında nonsteroid antiinflamatuar ilaç (NSAİİ), ortanca birinci ayda (ÇAA: 3 ay) ise kDMARD başlandı. Bu hastalarda en sık başlanan tedavi metotreksat (MTX)(%97.2) idi. kDMARD 21 hastada (%29.5) etkili olurken, 50 hasta (%70.4)’nın kDMARD tedavisine direnç gösterip bDMARD’a ihtiyaç duyduğu saptandı. kDMARD'a yanıt veren grup ile dirençli grup karşılaştırıldığında, aile öyküsü yanıt verenlerde daha yaygındı (%23.6, p=0.044), ayak bileği tutulumu ise dirençli grupta daha sıktı (%38, p=0.016). Tek değişkenli analizde, ayak bileği/ayak parmağı eklemi tutulumu kDMARD tedavisine direnç açısından risk faktörü (p=0.027, %95 GA), aile öyküsü olması ise koruyucu faktör olarak (p=0.043, %95 GA) belirlenmiştir. Tek değişkenli analizde anlamlı olan değişkenlerle çok değişkenli analiz yapıldığında, sadece ayak bileği/ayak parmağı eklemi tutulumu istatistiksel olarak anlamlı bulunmuştur (ayak bileği/ayak parmağı eklemi OR=5.29 %95 GA (1.08-25.83), p=0.040, aile öyküsü OR=0.24 %95 GA (0.05-1.19), p=0.080). Sonuç: Oligoartiküler JİA'lı hastalarda, tanı anında ayak bileği/ayak parmağı eklemi tutulumu, kDMARD tedavisine direnç riskini artırmaktadır. Bu nedenle, bu hastaların takiplerinde dikkatli izlem gerekmektedir. Anahtar Kelimeler: Hastalık modifiye edici antiromatizmal ilaçlar, oligoartiküler jüvenil idiyopatik artrit, öngörücü faktörler, dirençli hastalık

Anahtar Kelimeler

• Hastalığı modifiye edici antiromatizmal ilaçlar
• oligoartiküler juvenil idiyopatik artrit
• öngörücü faktörler
• dirençli hastalık

Kaynakça

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