Juvenil İdiopatik Artritli Çocuklarda Komorbid Hastalıkların Analizi ve Hastalık Sürecine Etkisi

Abstract

Amaç: Komorbiditeler bir indeks hastalığın seyrinde var olan ya da sonradan ortaya çıkan durumlar olarak tanımlanır. Kronik hastalıklarda eşlik eden komorbidite varlığı hastalık sürecine etki edebilir. Juvenil idiopatik artrit (JİA) çocukluk çağının nedeni belli olmayan kronik artritidir. Bu çalışmada JİA hastalarında eşlik eden komorbiditeleri incelemek ve hastalık seyrine etkilerini araştırmak amaçlandı. Araçlar ve Yöntem: 2005-2021 yıllarında merkezimizde takip edilen ILAR kriterlerine göre JİA tanısı almış 18 yaş altındaki hastalar dahil edildi. JİA’ya eşlik eden tıbbi dosyalara kaydedilmiş tüm ek hastalıklar komorbidite olarak değerlendirildi. Komorbidite eşlik eden ve etmeyen hastalarda JİA hastalık aktivite (JADAS27, JSPADAS), hasar (JADI-A, JADI-E) ve sağlık değerlendirme anket (CHAQ) skorları ve JİA tedavileri karşılaştırıldı. Bulgular: Çalışmada 204 hasta vardı. Hastaların yaş ortanca değeri 13 (4-17.5) yıl, takip süresi ortanca değeri 5 (2-16) yıl idi. Hastaların 99’unda (%48.5) en az bir komorbidite saptandı. Birden fazla komorbidite saptanan hasta sayısı 24 (%11.8) idi. En sık saptanan komorbidite AAA (n=31 (%15.2)) idi. Ardından 23 (%11.3) hastada üveit vardı. JADAS 27, JSPADAS skorları komorbidite varlığına göre farklılık göstermedi (sırasıyla, p=0.55, p=0.63). İki grup arasında JADI-A, JADI-E skorlarında farklılık yoktu (sırasıyla, p=0.45, p=0.11). CHAQ skoru da komorbidite olanlarda farklı değildi (CHAQ disability: p=0.62; CHAQ discomfort: p=0.61; CHAQ pain: p= 0.32). Biyolojik ilaç kullanımı komorbidite olanlarda 42 (%42.4), olmayanlarda 43 (%41) idi (p=0.83). Adalimumab kullanımı komorbidite eşlik edenlerde daha fazlaydı (Komorbidite olanlarda: n=22 (%22.2); olmayanlarda: n=11 (%10.5); (p=0.02)). Sonuç: Komorbidite varlığının hastalık aktivite, hasar ve sağlık değerlendirme anket skorlarına etkisi saptanmamasına rağmen komorbidite varlığına göre JİA tedavi seçimi değişmektedir.

Keywords

• chronic disease
• arthritis
• comorbidity
• juvenile

Title: Analysis of Comorbid Diseases in Children with Juvenile Idiopathic Arthritis and Their Effects on the Disease Process

Abstract

Purpose: Comorbidities are conditions that exist or occur during an index disease course. Comorbidities may affect the chronic disease process. Juvenile idiopathic arthritis (JIA) is a chronic childhood arthritis of unknown etiology. We aimed to evaluate comorbidities associated with JIA and their effects on the course of the disease. Materials and Methods: We included patients under 18 years of age with JIA in our center between 2005 and 2021. All diseases accompanying JIA and recorded in the medical records were considered as comorbidities. JIA disease activity indexes (JADAS27, JSPADAS), damage index (JADI-A, JADI-E), and health assessment questionnaire index (CHAQ) and JIA treatments were compared according to the presence of comorbidity. Results: Two hundred and four patients were included in the study. The median age was 13(4-17.5) years, and the median follow-up time was 5(2-16) years. Ninety-nine (48.5%) patients had at least one comorbidity. Twenty-four patients had more than one comorbidity. The most common comorbidity was FMF (n=31 (15.2%)), followed by uveitis in 23 (11.3%). JADAS 27, and JSPADAS were indifferent in patients with comorbidity (p=0.55, p=0.63, respectively). JADI-A, JADI-E, and CHAQ scores were similar in the two groups (JADI-A:p=0.45; JADI-E:p=0.11; CHAQ disability:p=0.62; CHAQ discomfort:p=0.61; CHAQ pain:p=0.32). Forty-two (42.4%) patients with comorbidities and 43 (41%) patients without comorbidity used biological drugs (p=0.83). Adalimumab treatment was higher in those with comorbidity (patients with comorbidity:n=22 (22.2%); without comorbidity:n=11 (10.5%); p=0.02). Conclusion: Although comorbidity did not affect disease activity, damage score, and Health Assessment Questionnaire index, the JIA treatment varied according to comorbidity.

Keywords

• arthritis
• chronic disease
• comorbidity
• juvenile

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