Clinical and Laboratory Characteristics and Follow Up Results of 121 Children with Juvenile Idiopathic Arthritis

Abstract

This study aimed to investigate the clinical and laboratory features of children with juvenile idiopathic arthritis (JIA) that followed up at Dicle University Hospital Department of Pediatrics. Totally, 121 (64 male, 57 female) children with the mean age of 10.0±4.1 (range, 1.5-1.8) years were included. The mean disease onset age was 7.9±3.8 (range, 0.8-15.4) years and the mean follow up period was 2.1±1.9 years. The percentages of JIA subtypes were as follows: Oligoarticular JIA 67 (55.4%), polyarticular 45 (37.2%), enthesitis related arthritis 5 (4.1%) and systemic JIA 4 (3.3%). The most common complaints were arthralgia (91.7%), fever (57.0%), fatigue (38.8%) and malaise (34.7%) and the most frequently involved joints were knee (74.4%), ankle (57.9) and wrist (48.8%). Complete remission were achieved in 28 (23.1%) and partial remission in 56 (46.3%), however 27 (21.3%) cases not responded to treatment satisfactorily. Significant risk factors for poor response to treatment with logistic regression were found as delay in treatment ≥6 months (Odds ratio, OR:11.1; p=0.006), existence of thrombocytosis (OR: 7.5; p=0.009) and early disease onset (age

Keywords

• Juvenile idiopathic arthritis, clinical findings, laboratory results, response to treatment

Clinical and Laboratory Characteristics and Follow Up Results of 121 Children with Juvenile Idiopathic Arthritis

Öz

Bu çalışmada Dicle Üniversitesi hastanesi Pediatri bölümünde izlenen Juvenil İdyopatik Artrit’li (JİA) çocukların klinik ve laboratuvar özelliklerinin araştırılması amaçlandı. Yaş ortalaması 10,0±4,1 (aralık, 1,5-1,8) yıl olan, toplam 121 JİA’lı çocuk (64 erkek, 57 kız) çalışmaya alındı. Ortalama hastalık başlama yaşı 7,9±3,8 (aralık, 0,8-15,4) yıl, ortalama takip süresi 2,1±1,9 yıl idi. Juvenil İdyopatik Artrit alt tipleri sayı ve yüzdeleri; oligoartiküler JİA 67 (%55,4), poliartiküler 45 (%37,2), entezit ilişkili artrit 5 (%4,4) ve sistemik JİA 4 (%3,3) idi. En sık şikayetler eklem ağrısı (%91,7), ateş (%57,0), yorgunluk (%38,8) ve halsizlik (%34,7) idi. En sık etkilenen eklemler; diz (%74,4), ayak bileği (%57,9) ve el bileği (%48,8) idi. Tam remisyon 28 (%23,1) hastada, kısmi remisyon 56 (%46,3) hastada gözlenirken, 27 (%21,2) hasta tedaviye yeterli yanıt vermedi. Lojistik regresyon analizi ile, tedaviye başlamada ≥6 ay gecikme (OR:11,1; p=0,006), trombositoz varlığı (OR:7,5; p=0,009) ve hastalığın erken başlaması (˂5 yaş) (OR:18,1; p=0,004) tedaviye yetersiz yanıt için anlamlı risk faktörleri olarak saptandı. Sonuç olarak JIA çocukluk çağının değişik klinik belirtilerle seyreden heterojen bir hastalığıdır. Hastalığın erken başlaması, tanı ve tedavide gecikme ve trombositoz varlığı olumsuz sonuç için anlamlı risk faktörleri olarak bulundu

Anahtar Kelimeler

• Juvenil idyopatik artrit, klinik bulgular, laboratuvar bulguları, tedaviye yanıt

Kaynakça

1. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007;369:767-78.
2. Helmick CG, Felson DT, Lawrence RC, et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008;58:15-25.
3. Ozen S, Karaaslan Y, Ozdemir O, Saatci U, Bakkaloglu A, Koroglu E, Tezcan S. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol 1998;25:2445-9.
4. Özdoğan H, Kasapçopur O, Dede H, et al. Juvenile chronic arthritis in a Turkish Population. Clin Exp Rheumatology 1991;9:431 -51.
5. Khan P. Juvenile idiopathic arthritis: an update on pharma- cotherapy. Bulletin of the NYU Hospital for Joint Diseases 2011;69:264-76.
6. Petty RE, Southwood TR, Baum J. Revision of the proposed classification for juvenile idiopathic arthritis: Durban 1997. J Rheumatol 1998;25:1991-4.
7. Behrens EM, Beukelman T, Gallo L, et al. Evaluation of the presentation of systemic onset juvenile rheumatoid arthri- tis: data from the Pennsylvania Systemic Onset Juvenile Arthritis Registry (PASOJAR). J Rheumatol 2008;35:343-8.
8. Huang H, Qian X, Yu H, Li J, Zhang Y. Clinical analysis in 202 children with juvenile idiopathic arthritis. Clin Rheumatol 2013;32:1021-7.

9. Adelowo OO, Umar A. Juvenile idiopathic arthritis among Nigerians: a case study. Clin Rheum 2010;29:757-61.
10. Qin Z, Jiang X, Lin Y, Shen Z, Dong S. Clinical characteris- tics of 228 cases with juvenile idiopathic arthritis. J Applied Clinical Pediatrics 2008;21:12-7.
11. Pan Y, Ma S, Yao Y, Zhen X. Diagnostic criteria and classifi- cation in 229 children with juvenile idiopathic arthritis. J Applied Clinical Pediatrics 2007;22:1636-41.
12. Ravelli A. Toward an understanding of the long-term out- come of juvenile idiopathic arthritis. Clin Exp Rheumatol 2004;22:271-5.
13. Fantini F, Gerloni V, Gattinara M, Cimaz R, Arnoldi C, Lupi E. Remission in juvenile chronic arthritis: a cohort study of 683 consecutive cases with a mean 10-year follow-up. J Rheumatol 2003;30:579-84.
14. Flat B, Lien G, Smerdel A, et al. Prognostic factors in ju- venile rheumatoid arthritis: a case–control study revealing early predictors and outcome after 14.9 years. J Rheumatol 2003;30:386-93.
15. Wells G, Becker JC, Teng J, et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on eryth- rocyte sedimentation rate. Ann Rheum Dis 2009;68:954-60.
16. Gare BA. The outcome of juvenile idiopathic arthritis. Current Pediatrics 2003;13:327-34.