Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
J Rheumatol. 2011 May;38(5):954-8. doi: 10.3899/jrheum.101146. Epub 2011 Feb 1.
Hip involvement occurs in 20%-40% of all cases of juvenile idiopathic arthritis (JIA). Patients with systemic JIA (sJIA) are affected most frequently. The aim of our study was to investigate the predictors of clinical hip disease and radiographic hip damage in sJIA.
The medical records (1997-2007) of all children (n = 98) with sJIA were reviewed. Potential clinical and laboratory predictors were examined at presentation and at 3 and 6 months. To account for censored observations, we used survival analysis.
During the study period, 59 children met our inclusion criteria. The mean age at diagnosis was 7.8 years. Thirty patients (51%) developed clinical hip disease, with 12 (20%) developing radiographic evidence of hip damage. The median time to develop clinical hip disease was 24 months. Using Kaplan-Meier estimates, 25% of patients develop radiographically evident hip damage within 43 months. At presentation, patients in whom clinical hip disease later developed had polyarthritis (hazard ratio 2.51, p = 0.01), elevated IgG (HR 1.12, p = 0.01) and IgM (HR 2.71, p = 0.02), and higher CHAQ scores (HR 1.65, p = 0.02). At 3 months after disease onset, patients in whom radiographic hip damage later developed had fever (HR 4.78, p = 0.02), polyarthritis (HR 4.63, p = 0.02), and higher CHAQ scores (HR 3.20, p = 0.005). At 6 months, polyarthritis was the strongest predictor of both clinical hip disease and radiographic hip damage.
Half of patients with sJIA develop clinical hip disease a median time of 24 months from diagnosis. Early identification of predictors of hip disease and damage in patients with sJIA may suggest earlier, more aggressive interventions to prevent joint destruction.
髋关节受累发生于 20%-40%的所有幼年特发性关节炎（JIA）病例中。全身型幼年特发性关节炎（sJIA）患者最常受累。本研究旨在探讨 sJIA 患者临床髋关节疾病和放射影像学髋关节损伤的预测因素。
回顾分析了 1997 年至 2007 年间所有（n=98）sJIA 患儿的病历。在初诊时和 3 个月及 6 个月时检查潜在的临床和实验室预测因素。为了考虑截尾观察，我们使用了生存分析。
在研究期间，59 名患儿符合纳入标准。诊断时的平均年龄为 7.8 岁。30 名患者（51%）出现了临床髋关节疾病，12 名患者（20%）出现了放射影像学髋关节损伤的证据。出现临床髋关节疾病的中位时间为 24 个月。使用 Kaplan-Meier 估计，25%的患者在 43 个月内出现放射影像学明显的髋关节损伤。初诊时，后来出现临床髋关节疾病的患者有关节炎（风险比 2.51，p=0.01）、高 IgG（风险比 1.12，p=0.01）和 IgM（风险比 2.71，p=0.02）和更高的 CHAQ 评分（风险比 1.65，p=0.02）。在疾病发作后 3 个月时，后来出现放射影像学髋关节损伤的患者有发热（风险比 4.78，p=0.02）、关节炎（风险比 4.63，p=0.02）和更高的 CHAQ 评分（风险比 3.20，p=0.005）。在 6 个月时，关节炎是临床髋关节疾病和放射影像学髋关节损伤的最强预测因素。
半数 sJIA 患者在诊断后 24 个月出现临床髋关节疾病。早期识别 sJIA 患者髋关节疾病和损伤的预测因素可能提示更早、更积极的干预措施以预防关节破坏。
