Nordal Ellen, Zak Marek, Aalto Kristiina, Berntson Lillemor, Fasth Anders, Herlin Troels, Lahdenne Pekka, Nielsen Susan, Straume Bjørn, Rygg Marite
Department of Pediatrics, University Hospital of North Norway and University of Tromsø, Tromsø, Norway.
Arthritis Rheum. 2011 Sep;63(9):2809-18. doi: 10.1002/art.30426.
To describe the disease characteristics, long-term course, and outcome of patients with juvenile idiopathic arthritis (JIA) in a population-based setting.
Consecutive cases of JIA from defined geographic areas of Denmark, Finland, Sweden, and Norway in whom disease onset occurred in 1997-2000 were included in a prospective, multicenter cohort study. The study was designed to be as close to a population-based study as possible, with centers participating only if they were able to include in their catchment area all children in whom JIA was diagnosed.
Of 500 children included, 440 (88.0%) had repeated visits, with the last visit occurring at least 7 years after disease onset (median 98 months, range 84-147 months). Changes in the International League of Associations for Rheumatology category were observed in 10.8% of the children, and, in addition, extended oligoarthritis developed in 34.7% of the group with oligoarticular JIA. During the observation period, 58.0% of the children were treated with disease-modifying antirheumatic drugs, including biologic medications. Ongoing disease activity was mostly mild, but some JIA-related damage developed in 22.9% of the children. At the last followup visit, remission off medication was observed in 42.4% of the children, 8.9% were in remission on medication, and 48.7% were not in remission. The highest rates of remission were observed in patients with persistent oligoarticular JIA and in those with systemic JIA.
In this long-term prospective study of JIA in a population-based Nordic setting, ongoing disease was evident in a majority of the children. The present results underline the need to identify early predictors of outcome, to further improve therapy, and to continue long-term followup of patients with JIA.
在基于人群的背景下描述幼年特发性关节炎（JIA）患者的疾病特征、长期病程及转归。
1997年至2000年疾病发作的丹麦、芬兰、瑞典和挪威特定地理区域的JIA连续病例被纳入一项前瞻性多中心队列研究。该研究设计尽可能接近基于人群的研究，只有当中心能够将其集水区内所有被诊断为JIA的儿童纳入时才参与。
纳入的500名儿童中，440名（88.0%）有多次随访，最后一次随访发生在疾病发作至少7年后（中位数98个月，范围84 - 147个月）。10.8%的儿童出现了国际风湿病联盟分类的变化，此外，寡关节型JIA组中34.7%发展为扩展性寡关节炎。在观察期内，58.0%的儿童接受了改善病情抗风湿药物治疗，包括生物制剂。疾病活动大多较轻，但22.9%的儿童出现了一些与JIA相关的损害。在最后一次随访时，42.4%的儿童停药后缓解，8.9%在用药时缓解，48.7%未缓解。持续性寡关节型JIA患者和全身型JIA患者的缓解率最高。
在这项基于北欧人群的JIA长期前瞻性研究中，大多数儿童存在持续性疾病。目前的结果强调了识别结局早期预测因素、进一步改善治疗以及继续对JIA患者进行长期随访的必要性。
