Güneydoğu Anadolu Bölgesi jüvenil idiyopatik artrit hastalarında alt tip dağılımı ve üveit sıklığı

Öz

Amaç: Juvenil idiyopatik artrit (JİA) tüm dünyada en sık gözlenen çocukluk çağı romatizmal hastalığıdır. Tek bir hastalık olmayıp alt gruplardan oluşmaktadır. Kas iskelet sistemi dışında üveit şeklinde göz tutulumu önemli bir morbidite nedenidir. Çalışmamızın amacı kliniklerimizde takip edilen JİA hastaların alt tip dağılımını ve üveit sıklığını saptamaktır.

Metod: Kliniklerimizde JİA tanısı ile takip ve tedavi edilen tüm hastaların dosyaları geriye dönük olarak taranmıştır.

Bulgular: Çalışmamıza 264 JİA hastası dahil edilmiştir. Hastaların %54.9’u kız iken %45.1’i erkek idi ve ortalama takip süresi 13.8 ± 5.8 ay idi. JİA alt tip dağılımına bakıldığında en sık oligoartiküler JİA (%42.4) gözlenmekte idi. Entezit ilişkili artrit (%21.6) ikinci sırada iken diğer JİA alt tip dağılımı şu şekilde idi; sistemik JİA (%13.6), romatoid faktör (RF) negatif poliartiküler JİA (%10.2), RF pozitif poliartiküler JİA (%9.5), psoriatik artrit (%1.9) ve sınıflandırılamayan artrit (%0.8). Üveit toplam 23 hastada (%8.7) gözlenmiş olup üveit hastalarının %91.3’ü oligoartiküler JİA grubunda idi. Sistemik JİA hastalarının %13.8’inde makrofaj aktivasyon sendromu gözlendi. Son kontroldeki hastalık aktivitesine bakıldığında hastaların %18.6’sı aktif iken %81.4’ü remisyonda takip edilmekteydi.

Sonuç: Ülkemizde en sık gözlenen JİA alt tipi diğer ülkelerde olduğu gibi oligoartiküler JİA’dır. Ancak batı ülkelerinden farklı olarak ikinci en sık gözlenen alt tip entezit ilişkili artrittir. Ülkemiz JİA hastalarının diğer bir farkı da, JİA ilişkili üveitin daha az gözlenmesidir. Oligoartiküler JİA üveitin en sık gözlendiği alt gruptur. Güncel tedavi seçeneklerinin artması ile hastaların büyük çoğunluğunda hastalık remisyonu sağlanabilmektedir.

Anahtar Kelimeler

• juvenile idiopatik artrit,üveit

Subtype distribution and frequency of uveitis in Southeastern Anatolian children with juvenile idiopathic arthritis

Abstract

Aim: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood in the world. It is not a single disease rather composed of distinct subtypes. Apart from musculoskeletal complications, uveitis is one of the major causes of morbidity in JIA. The aim of this study was to demonstrate subtype distribution and frequency of uveitis in JIA.

Method: The study was conducted in two pediatric rheumatology centers of Southeastern part of Turkey.

Results: The cohort consisted of 264 children with slightly female predominance (females: 54.9%, males: 45.1%). Mean duration of follow-up was 13.8 ± 5.8 months. The most common subtype was oligoarticular JIA (42.4%) followed by enthesitis related arthritis (21.6%). The distribution of other subtypes were as follows; systemic JIA (13.6%), rheumatoid factor (RF) negative polyarticular JIA (10.2%), RF positive polyarticular JIA (9.5%), psoriatic arthritis (1.9%) and unclassified arthritis (0.8%). The frequency of uveitis was 8.7% and 91.3% of the patients with uveitis had oligoarticular JIA. Macrophage activation syndrome was observed in 13.8% of systemic JIA patients. While 18.6% of the patients had active disease at the time of enrollment, 81.4% had remission.

Conclusion: As in other parts of the world, oligoarticular JIA is the most common subtype in our country. But, in contrast to western countries, enthesitis related arthritis is the second most common subtype in Turkey. The frequency of uveitis is low in Turkish JIA children that is another major difference from the western countries and oligoarticular JIA is the most common subtype associated with uveitis. With the introduction of newer treatment modalities, remission is an achievable goal in most of the JIA patients.

Keywords

• juvenile idiopathic arthritis,uveitis

Kaynakça

1. 1) Crayne CB, Beukelman T. Juvenile idiopathic arthritis: Oligoarthritis and polyarthritis. Pediatr Clin North Am. 2018;65:657-674.
2. 2) Petty RE, Laxer RM, Lucy R, Wedderburn LR. Juvenile Idiopathic Arthritis. In: Petty RE, Laxer RM, Lindsey CB, Wedderburn LR, editors. Textbook of Pediatric Rheumatology. 7th ed. Philadelphia: Elsevier; 2016. pp 188-204.
3. 3) 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;31:390-392.
4. 4) Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, et al; Pediatric Rheumatology International Trials Organization (PRINTO). Toward new classsification criteria for juvenile idiopathic arthritis: First steps, Pediatric Rheumatology International Trials Organization international concencus. J Rheumatol 2019;46:190-197.
5. 5) Consolaro A, Giancane G, Alongi A, van Dijkhuizen EHP, Aggarwal A, Al-Mayouf SM, et al; Paediatric Rheumatology International Trials Organisation. Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study. Lancet Child Adolesc Health 2019;3:255-263.
6. 6) Demirkaya E, Ozen S, Bilginer Y, Ayaz NA, Makay BB, Unsal E, et al. The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish Paediatric Rheumatology Association. Clin Exp Rheumatol 2011;29:111-116.
7. 7) Comak E, Dogan CS, Akman S, Koyun M, Gokceoğlu AU, Keser I. MEFV gene mutations in Turkish children with juvenile idiopathic arthritis. Eur J Pediatr 2013;172:1061-1067.
8. 8) Otar Yener G, Ekici Tekin Z, Akdağ B, Yüksel S. Jüvenil idiyopatik artrit – Pamukkale Universitesi deneyimi. 4. Çocuk Romatoloji Kongresi, 2018, SS015.

9. 9) Çakan M, Aktay-Ayaz N, Keskindemirci G, Ekinci DY, Karadağ ŞG. Subtype frequencies, demographic features and remission rates in juvenile idiopathic arthritis – 265 cases from a Turkish center. Turk J Pediatr 2017;59:548-554.
10. 10) Tugal-Tutkun I, Quartier P, Bodaghi B. Disease of the year: juvenile idiopathic arthritis-associated uveitis--classification and diagnostic approach. Ocul Immunol Inflamm 2014;22:56-63.
11. 11) Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 2005;140:509-516.
12. 12) Wallace CA, Giannini EH, Huang B, Utert L, Ruperto N; Childhood Arthritis Rheumatology Research Alliance; Pediatric Rheumatology Collaborative Study Group; Pediatric Rheumatology International Trials Organization. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011;63:929-936.
13. 13) Ravelli A, Grom AA, Behrens EM, Cron RQ. Macrophage activation syndrome as part of systemic juvenile idiopathic arthritis: diagnosis, genetics, pathophysiology and treatment. Genes Immun 2012;13:289-298.
14. 14) Ayaz NA, Ozen S, Bilginer Y, Ergüven M, Taşkiran E, Yılmaz E, et al. MEFV mutations in systemic onset juvenile idiopathic arthritis. Rheumatology (Oxford) 2009;48:23-25.
15. 15) Singh-Grewal D, Schneider R, Bayer N, Feldman BM. Predictors of disease course and remission in systemic juvenile idiopathic arthritis: significance of early clinical and laboratory features. Arthritis Rheum. 2000;54:1595-1601.
16. 16) Kasapçopur O, Yologlu N, Ozyazgan Y, Ercan G, Caliskan S, Sever L, et al. Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis. Indian Pediatr 2004;41:1035-1039.
17. 17) Ozdogan H, Kasapçopur O, Dede H, Arisoy N, Beceren T, Yurdakul S, et al. Juvenile chronic arthritis in a Turkish population. Clin Exp Rheumatol 1991;9:431-435.
18. 18) Ravelli A, Consolaro A, Horneff G, Laxer RM, Lovell DJ, Wulffrat NM, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis 2018;77:819-828.
19. 19) Ravelli A, Martini A. Remission in juvenile idiopathic arthritis. Clin Exp Rheumatol 2006;24:S105-110.
20. 20) Otar Yener G, Ekici Tekin Z, Yuksel S. Psoriatic fasciitis in a pediatric patient: A case report. World J Clin Cases 2019;7:68-72.