Flatø Berit, Lien Gunhild, Smerdel Anna, Vinje Odd, Dale Knut, Johnston Virginia, Sørskaar Dag, Moum Torbjørn, Ploski Rafal, Førre Øystein
Center for Rheumatic Diseases, Rikshospitalet University Hospital, Oslo, Norway.
J Rheumatol. 2003 Feb;30(2):386-93.
To describe the physical and psychosocial outcome in patients with juvenile rheumatoid arthritis (JRA), compared with subjects in the general population, and to determine patient characteristics, HLA alleles, and disease variables within the first 6 months of disease onset that predict persistent disease, joint erosions, and physical disability.
A cohort of 268 (85%) of 316 patients with JRA first admitted to the hospital between 1980 and 1985 were examined after a median of 14.9 years (range 11.7-25.1) of disease duration. Controls matched for age, sex, and geographic region were randomly selected from the general population. Patients' medical records were retrospectively reviewed. Clinical examinations and radiographs of the hips, ankles, and affected joints were obtained. HLA-DRB1 and DPB1 alleles were determined by genotyping and HLA-B27 by serologic testing. Physical and psychosocial health status was assessed using the Short-Form Health Survey (SF-36) and the Health Assessment Questionnaire (HAQ).
At followup, 133 patients with JRA (50%) were in remission, 63 (24%) had developed joint erosions, and 93 (36%) had impaired physical functioning (HAQ > 0.0). Patients had greater disability, more bodily pain, and poorer general health than controls. Comparable levels of education, social function, and mental health were found, but the patients had higher rates of unemployment than controls (19% vs 7%; p < 0.001). Predictors of persistent disease and joint erosions were: young onset age and large numbers of affected joints, long duration of elevated erythrocyte sedimentation rate (ESR), and positive IgM rheumatoid factor (RF) within the first 6 months. Additionally, persistent disease was predicted by the presence of DRB108, and joint erosions were predicted by symmetric arthritis and DRB108 and HLA-B27 in combination. DRB1*01 was a predictor of joint erosions in the pauciarticular onset type (n = 163). Predictors of physical disability were: female sex, symmetric arthritis, hip joint involvement, long duration of elevated ESR and IgM RF.
Compared with healthy controls, patients with JRA had impaired physical health and lower employment rates after more than 11 years of disease duration. Elevated ESR, extensive and symmetric arthritis, positive IgM RF, DRB108, DRB101, HLA-B27 and DRB1*08 in combination, early onset, and female sex were early risk factors for an unfavorable outcome.
描述青少年类风湿关节炎（JRA）患者与普通人群相比的身体和心理社会结局，并确定疾病发作后前6个月内预测疾病持续、关节侵蚀和身体残疾的患者特征、HLA等位基因及疾病变量。
对1980年至1985年间首次入院的316例JRA患者中的268例（85%）进行了检查，疾病持续时间中位数为14.9年（范围11.7 - 25.1年）。从普通人群中随机选取年龄、性别和地理区域匹配的对照。对患者的病历进行回顾性审查。获取髋部、踝部及受累关节的临床检查和X线片。通过基因分型确定HLA - DRB1和DPB1等位基因，通过血清学检测确定HLA - B27。使用简短健康调查（SF - 36）和健康评估问卷（HAQ）评估身体和心理社会健康状况。
随访时，133例JRA患者（50%）处于缓解期，63例（24%）出现关节侵蚀，93例（36%）身体功能受损（HAQ > 0.0）。与对照组相比，患者残疾程度更高、身体疼痛更多、总体健康状况更差。在教育水平、社会功能和心理健康方面发现了相当的水平，但患者的失业率高于对照组（19%对7%；p < 0.001）。疾病持续和关节侵蚀的预测因素为：发病年龄小、受累关节数量多、红细胞沉降率（ESR）升高持续时间长以及疾病发作后前6个月内IgM类风湿因子（RF）阳性。此外，DRB108的存在可预测疾病持续，对称关节炎以及DRB108和HLA - B27联合可预测关节侵蚀。DRB1*01是少关节型发病类型（n = 163）中关节侵蚀的预测因素。身体残疾的预测因素为：女性、对称关节炎、髋关节受累、ESR升高持续时间长和IgM RF阳性。
与健康对照组相比，JRA患者在疾病持续11年以上后身体健康受损且就业率较低。ESR升高、广泛对称的关节炎、IgM RF阳性、DRB108、DRB101、HLA - B27以及DRB1*08联合、发病早和女性是不良结局的早期危险因素。
