Arthritis Research Campaign Epidemiology Unit, Stopford Building, University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester M13 9PT, UK.
Rheumatology (Oxford). 2010 Jan;49(1):116-22. doi: 10.1093/rheumatology/kep352. Epub 2009 Nov 19.
Inflammatory arthritis in childhood is variable in terms of both presentation and outcome. This analysis describes disease activity in children with juvenile idiopathic arthritis (JIA) during the first year following presentation to a paediatric rheumatologist and identifies predictors of moderate to severe disability [defined using a Childhood HAQ (CHAQ) score >or=0.75] at 1 year.
The Childhood Arthritis Prospective Study recruits children <16 years with new inflammatory arthritis persisting for >or=2 weeks from five UK tertiary referral centres. Demographics, disease features, joint count, CHAQ, physician's global assessment, parent's general evaluation of well-being (PGE), ESR and treatment, are collected at first presentation, 6 months and then yearly. Independent predictors of CHAQ >or=0.75 at 1 year in children diagnosed with JIA were identified using multivariable logistic regression models.
Seven hundred and forty children with JIA were included; median age at presentation 7.6 years, 64% girls. During the first year, 85% received NSAIDs, 70% IA corticosteroids, 47% MTX and 27% systemic steroids (oral or i.v.). Median presenting CHAQ score was 0.63 and decreased to 0.25 at 1 year; 32% had CHAQ >or=0.75 at 1 year. The strongest predictor of CHAQ >or=0.75 at 1 year was CHAQ >or=0.75 at presentation (odds ratio 3.92; 95% CI 2.17, 7.09). Additional predictors included female gender and higher PGE.
Although CHAQ score improved in most children, the strongest predictor of persistent disability at 1 year was moderate to severe disability at first presentation. Follow-up beyond 1 year will assess whether CHAQ at presentation will continue to be a predictor of future poor outcome.
儿童时期的炎症性关节炎在表现和结果方面均存在差异。本分析描述了在向儿科风湿病医生就诊后的第一年中，幼年特发性关节炎（JIA）患儿的疾病活动情况，并确定了 1 年内达到中度至重度残疾[使用儿童 HAQ（CHAQ）评分>或=0.75 定义]的预测因素。
儿童关节炎前瞻性研究从英国五个三级转诊中心招募了新出现持续>或=2 周的炎症性关节炎且年龄<16 岁的儿童。在首次就诊、6 个月和随后每年收集人口统计学、疾病特征、关节计数、CHAQ、医生总体评估、家长对患儿整体健康状况的总体评估（PGE）、ESR 和治疗情况。使用多变量逻辑回归模型确定了在诊断为 JIA 的儿童中，1 年内 CHAQ>或=0.75 的独立预测因素。
共纳入 740 例 JIA 患儿，中位发病年龄为 7.6 岁，64%为女孩。在第一年中，85%的患儿接受 NSAIDs、70%的患儿接受 IA 皮质类固醇、47%的患儿接受 MTX 和 27%的患儿接受全身皮质类固醇（口服或静脉注射）。中位初始 CHAQ 评分为 0.63，1 年后降至 0.25；32%的患儿在 1 年内 CHAQ>或=0.75。1 年内 CHAQ>或=0.75 的最强预测因素是首次就诊时 CHAQ>或=0.75（比值比 3.92；95%CI 2.17，7.09）。其他预测因素包括女性性别和较高的 PGE。
尽管大多数患儿的 CHAQ 评分有所改善，但 1 年内持续残疾的最强预测因素是首次就诊时即存在中度至重度残疾。超过 1 年的随访将评估就诊时的 CHAQ 评分是否将继续成为未来不良结局的预测因素。
