Pediatria II, Reumatologia, IRCCS G. Gaslini, Genoa, Italy Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Ann Rheum Dis. 2015 Nov;74(11):1996-2005. doi: 10.1136/annrheumdis-2014-205265. Epub 2014 Jun 24.
Juvenile idiopathic arthritis (JIA) is subdivided into seven categories. Even within these categories, the prognosis varies markedly. To start appropriate treatment in patients with JIA and to inform patients and their parents correctly, it is essential to know the individual prognosis, preferably at the time of diagnosis. The aim of this study was to identify variables that predict disease activity, joint damage, functional ability and quality of life (QoL) early in the disease course.
A systematic literature review was performed, and 3679 articles were identified. The results were screened and critically appraised using predefined criteria. Articles that described validated outcomes, such as the Wallace criteria, the childhood health assessment questionnaire (CHAQ) and the juvenile arthritis damage index (JADI), and that determined predictors in the first 6 months of disease were selected.
Forty mostly retrospective articles were selected. Polyarticular onset predicted a worse prognosis for all outcomes, except QoL. A diagnostic delay and the systemic category predicted continuation of active disease. Notably, antinuclear antibodies (ANA) did not predict disease activity. Symmetric involvement and rheumatoid factor positivity predicted less damage. More disease activity was mainly associated with worse functional outcome. However, most predictors were not validated.
Few predictors for the selected outcomes were found. Prospective, longitudinal studies using standardised outcome measurements, and evaluating a broader range of predictors, such as genetics, immunological and imaging data, should be performed. For the outcomes joint assessment and quality of life, standardised and validated outcomes should be developed.
幼年特发性关节炎（JIA）分为七类。即使在这些类别中，预后也有很大差异。为了在 JIA 患者中开始适当的治疗，并正确告知患者及其父母，了解个体预后至关重要，最好在诊断时就了解。本研究的目的是确定在疾病早期能够预测疾病活动度、关节损伤、功能能力和生活质量（QoL）的变量。
进行了系统的文献回顾，共确定了 3679 篇文章。使用预设标准对结果进行筛选和严格评估。选择描述了经过验证的结果（如 Wallace 标准、儿童健康评估问卷（CHAQ）和幼年关节炎损伤指数（JADI））的文章，并确定了疾病最初 6 个月内的预测因素。
选择了 40 篇主要是回顾性的文章。多关节起病预测所有结局的预后较差，除了 QoL。诊断延迟和全身性分类预测持续存在活动期疾病。值得注意的是，抗核抗体（ANA）不能预测疾病活动度。对称性受累和类风湿因子阳性预测较少的损伤。更多的疾病活动度主要与较差的功能结局相关。然而，大多数预测因素未经验证。
仅发现了少数用于所选结局的预测因素。应进行前瞻性、纵向研究，使用标准化的结局测量，并评估更广泛的预测因素，如遗传学、免疫学和影像学数据。对于关节评估和生活质量结局，应制定标准化和验证的结局。
