Singh-Grewal D, Schneider R, Bayer N, Feldman B M
The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Arthritis Rheum. 2006 May;54(5):1595-601. doi: 10.1002/art.21774.
To determine whether the disease course in systemic juvenile idiopathic arthritis (JIA) can be characterized as monophasic, polycyclic, or persistent, and to determine whether early clinical and laboratory characteristics can be used to predict the disease course and time to remission.
Forty-five children with systemic JIA diagnosed between 1996 and 2000 were followed up with a standardized data collection protocol, including data on clinical and laboratory features (mean followup 4.9 years). Disease was considered inactive if the clinical and laboratory features were normal. Three definitions of remission were applied to classify disease course. Predictors of disease course were evaluated using multiple logistic regression. Predictors of time to remission were evaluated using Cox proportional hazards regression.
When applying a definition of remission requiring inactive disease while not receiving any medications for a period of 3 months, 42.2%, 6.7%, and 51.1% of the patients were classified as having monophasic, polycyclic, and persistent disease, respectively. Fever and active arthritis at 3 months (R2 = 0.42, area under the receiver operating characteristics curve [AUC] = 0.76) and an erythrocyte sedimentation rate (ESR) >26 mm/hour and corticosteroid use at 6 months (R2 = 0.49, AUC = 0.92) were predictive of a nonmonophasic course. Absence of active arthritis, an ESR of <26 mm/hour, and no requirement for corticosteroid therapy at 3 and 6 months were predictors of an earlier time to remission.
The disease course in systemic JIA can be characterized as monophasic, polycyclic, or persistent using a definition of remission requiring 3 months of inactive disease while not receiving any therapy. Features at 3 and 6 months are predictive of the disease course and time to remission.
确定全身型幼年特发性关节炎（JIA）的病程特征是单相性、多相性还是持续性，并确定早期临床和实验室特征是否可用于预测病程及缓解时间。
对1996年至2000年间诊断为全身型JIA的45例儿童采用标准化数据收集方案进行随访，包括临床和实验室特征数据（平均随访4.9年）。若临床和实验室特征正常，则认为疾病处于非活动期。应用三种缓解定义对病程进行分类。使用多元逻辑回归评估病程的预测因素。使用Cox比例风险回归评估缓解时间的预测因素。
当应用缓解定义为在未接受任何药物治疗的情况下疾病非活动3个月时，分别有42.2%、6.7%和51.1%的患者被分类为单相性、多相性和持续性疾病。3个月时发热和活动性关节炎（R2 = 0.42，受试者工作特征曲线下面积[AUC] = 0.76）以及6个月时红细胞沉降率（ESR）>26 mm/小时和使用皮质类固醇（R2 = 0.49，AUC = 0.92）可预测非单相病程。3个月和6个月时无活动性关节炎、ESR<26 mm/小时且无需皮质类固醇治疗是缓解时间较早的预测因素。
使用在未接受任何治疗的情况下疾病非活动3个月的缓解定义，全身型JIA的病程可特征化为单相性、多相性或持续性。3个月和6个月时的特征可预测病程及缓解时间。
