Taxter Alysha J, Wileyto E Paul, Behrens Edward M, Weiss Pamela F
From the Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Center for Epidemiology and Biostatistics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.J. Taxter, MD, Fellow, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; E.P. Wileyto, PhD, Associate Professor, Center for Epidemiology and Biostatistics, The University of Pennsylvania; E.M. Behrens, MD, Associate Professor, Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia; P.F. Weiss, MD, MSCE, Associate Professor, Department of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia.
J Rheumatol. 2015 Oct;42(10):1914-21. doi: 10.3899/jrheum.150092. Epub 2015 Sep 1.
Although there is increasing reliance on patient-reported outcomes (PRO) for disease management, there is little known about the differences in PRO across juvenile idiopathic arthritis (JIA) categories. The purpose of our study was to assess PRO across JIA categories, including pain, quality of life, and physical function, and to determine clinical factors associated with differences in these measures across categories.
This was a longitudinal cohort study of patients with JIA at a tertiary care pediatric rheumatology clinic. Subjects, PRO, and clinical variables were identified by querying the electronic medical record. Mixed-effects regression assessed pain, quality of life, and function.
Subjects with enthesitis-related arthritis (ERA) and undifferentiated JIA had significantly more pain, poorer quality of life, and poorer physical function. The ERA and undifferentiated JIA categories, physician's global disease activity assessment, female sex, and nonsteroidal antiinflammatory drug use were significantly associated with more pain, poorer quality of life, and poorer function. In models limited to ERA, female sex and tender enthesis count were significant predictors of decreased function.
ERA and undifferentiated JIA categories had poorer PRO than other JIA categories. Further work is needed to address ways to improve PRO in children with JIA, with a special focus on children with ERA and undifferentiated JIA.
尽管在疾病管理中越来越依赖患者报告的结局(PRO),但对于青少年特发性关节炎(JIA)各类型之间PRO的差异却知之甚少。我们研究的目的是评估JIA各类型的PRO,包括疼痛、生活质量和身体功能,并确定与这些指标在各类型之间差异相关的临床因素。
这是一项针对三级儿科风湿病诊所中JIA患者的纵向队列研究。通过查询电子病历确定受试者、PRO和临床变量。混合效应回归评估疼痛、生活质量和功能。
附着点炎相关关节炎(ERA)和未分化型JIA的受试者疼痛更明显、生活质量更差、身体功能更差。ERA和未分化型JIA类型、医生的整体疾病活动评估、女性性别以及使用非甾体抗炎药与更多疼痛、更差的生活质量和更差的功能显著相关。在仅限于ERA的模型中,女性性别和压痛附着点数是功能下降的显著预测因素。
ERA和未分化型JIA类型的PRO比其他JIA类型更差。需要进一步开展工作,以探讨改善JIA患儿PRO的方法,尤其要关注ERA和未分化型JIA患儿。