Flatø Berit, Hoffmann-Vold Anna-Maria, Reiff Andreas, Førre Øystein, Lien Gunnhild, Vinje Odd
Department of Rheumatology, Rikshospitalet-Radiumhospitalet Medical Center, 0027 Oslo, Norway.
Arthritis Rheum. 2006 Nov;54(11):3573-82. doi: 10.1002/art.22181.
To compare the clinical, functional, and radiographic outcomes in patients with enthesitis-related arthritis (ERA) with those in patients with other subtypes of juvenile idiopathic arthritis (JIA) and healthy controls, and to determine genetic markers, patient characteristics, and early disease variables that predict the development of remission, sacroiliitis, and physical limitations in ERA.
Fifty-five children with ERA who were first admitted to Rikshospitalet Medical Center between 1980 and 1985 were studied. Patients with oligoarthritis or polyarthritis who were admitted during the same period (n = 55) and individuals from a national population registry (n = 55) were matched for sex and age and used as controls. Health status was assessed after a median of 15.3 years of disease (range 11.7-21.9 years) and, in some patients, was reassessed after a median of 23.0 years (range 19.7-29.4 years) of disease, by use of the 36-item Short Form health survey and the Health Assessment Questionnaire. Clinical and radiographic examinations were performed at the 15-year followup visit. Variables relating to the onset of disease were retrospectively obtained by chart review. HLA alleles were determined by genotyping and serologic testing.
Patients with ERA had lower levels of physical functioning, poorer physical health, and more bodily pain compared with patients with oligoarthritis or polyarthritis (after a median of 15.3 and a median of 23.0 years) and normal controls (after a median of 15.3 years). Among patients with ERA, remission occurred in 44%, sacroiliitis was observed in 35%, and reduced spinal flexion was observed in 75%. Predictors of failure to attain disease remission included the following: ankylosing spondylitis (AS) in a first-degree relative, the presence of HLA-DRB108, and ankle arthritis within the first 6 months. HLA-DPB102 was a protective factor, whereas a persistently elevated erythrocyte sedimentation rate (ESR), and hip arthritis within the first 6 months were risk factors for sacroiliitis. Female sex, a family history of AS, and high numbers of affected joints within the first 6 months predicted poor physical health status after 23 years. Male sex was associated with reduced anterior flexion of the spine.
In this study, patients with ERA had poorer physical outcomes compared with patients with oligoarticular or polyarticular JIA and controls from the general population. A family history of related diseases, sex, the presence of HLA-DRB108, the absence of HLA-DPB102, a persistently elevated ESR, early hip or ankle arthritis, and high numbers of affected joints were predictors of an unfavorable outcome.
比较附着点炎相关关节炎（ERA）患者与其他亚型幼年特发性关节炎（JIA）患者及健康对照者的临床、功能和影像学结局，并确定预测ERA患者缓解、骶髂关节炎和身体功能受限发生的遗传标志物、患者特征及早期疾病变量。
对1980年至1985年间首次入住里克斯胡斯医院医疗中心的55例ERA患儿进行研究。将同期入院的少关节炎或多关节炎患者（n = 55）以及来自国家人口登记处的个体（n = 55）按性别和年龄匹配作为对照。在疾病中位病程15.3年（范围11.7 - 21.9年）后评估健康状况，部分患者在疾病中位病程23.0年（范围19.7 - 29.4年）后再次评估，采用36项简明健康调查问卷和健康评估问卷。在15年随访时进行临床和影像学检查。通过病历回顾回顾性获取与疾病发作相关的变量。通过基因分型和血清学检测确定HLA等位基因。
与少关节炎或多关节炎患者（在疾病中位病程15.3年和23.0年后）及正常对照者（在疾病中位病程15.3年后）相比，ERA患者的身体功能水平较低、身体健康状况较差且身体疼痛更多。在ERA患者中，44%实现缓解，35%观察到骶髂关节炎，75%观察到脊柱前屈减少。未达到疾病缓解的预测因素包括：一级亲属中有强直性脊柱炎（AS）、存在HLA - DRB108以及在最初6个月内出现踝关节关节炎。HLA - DPB102是一个保护因素，而红细胞沉降率（ESR）持续升高以及在最初6个月内出现髋关节关节炎是骶髂关节炎的危险因素。女性、AS家族史以及在最初6个月内受累关节数量多预测23年后身体健康状况不佳。男性与脊柱前屈减少有关。
在本研究中，与少关节型或多关节型JIA患者及一般人群对照相比，ERA患者的身体结局较差。相关疾病家族史、性别、存在HLA - DRB108、不存在HLA - DPB102、ESR持续升高、早期髋关节或踝关节关节炎以及受累关节数量多是不良结局的预测因素。
