Weiß Anja, Minden Kirsten, Listing Joachim, Foeldvari Ivan, Sieper Joachim, Rudwaleit Martin
German Rheumatism Research Center , Berlin , Germany.
German Rheumatism Research Center, Berlin, Germany; Charité University Medicine Berlin, Berlin, Germany.
RMD Open. 2017 Mar 21;3(1):e000366. doi: 10.1136/rmdopen-2016-000366. eCollection 2017.
To describe the course and the 4-year outcome of juvenile spondyloarthritis (jSpA).
Patients with a diagnosis of jSpA and an age at onset ≤16 years were included in the German Spondyloarthritis Inception cohort (GESPIC) and followed up prospectively for 4 years.
118 patients (73% men, 66% HLA-B27 positive, mean age 13.5 years, mean symptom duration 2.2 years) were enrolled in 2 study centres: 52% of patients with jSpA were captured by the enthesitis-related arthritis subgroup of the International League of Associations for Rheumatology classification criteria. At inclusion, the majority of patients had active peripheral arthritis (75.4%), followed by inflammatory back pain (IBP) (19.5%) and enthesitis (16.1%). There was a significant improvement in clinical manifestations and in patient-reported outcomes over time. During the 4-year follow-up, 85% of the patients had at least 1 period of remission on drug ≥6 months, and 46% of the patients achieved remission ≥12 months without medication, of whom 68% kept this status and 32% worsened. At the end of 4 years of observation, 23% of the patients were in remission without medication, but 57% still suffered from active disease. Patients with peripheral arthritis had a likelihood of 29% for having peripheral arthritis after 4 years, whereas the likelihood of IBP persistence was 53% for those with IBP at enrolment.
Although 1 quarter of patients with jSpA achieved remission off medication after 4 years, the likelihood of having recurrent or persistent disease into adulthood is substantial, particularly for jSpA with IBP.
NCT 01277419.
描述青少年脊柱关节炎（jSpA）的病程及4年预后。
诊断为jSpA且发病年龄≤16岁的患者纳入德国脊柱关节炎起始队列（GESPIC），并进行为期4年的前瞻性随访。
118例患者（73%为男性，66% HLA - B27阳性，平均年龄13.5岁，平均症状持续时间2.2年）在2个研究中心入组：52%的jSpA患者符合国际风湿病联盟分类标准中与附着点炎相关的关节炎亚组。入组时，大多数患者有活动性外周关节炎（75.4%），其次是炎性背痛（IBP）（19.5%）和附着点炎（16.1%）。随着时间推移，临床表现和患者报告的结局有显著改善。在4年随访期间，85%的患者至少有1次药物缓解期≥6个月，46%的患者在未用药情况下达到缓解≥12个月，其中68%维持该状态，32%病情恶化。在4年观察期结束时，23%的患者未用药处于缓解状态，但57%仍患有活动性疾病。外周关节炎患者4年后仍有外周关节炎发作的可能性为29%，而入组时患有IBP的患者IBP持续存在的可能性为53%。
尽管四分之一的jSpA患者在4年后未用药达到缓解，但成年后疾病复发或持续的可能性很大，特别是对于伴有IBP的jSpA患者。
NCT 01277419 。 （注：原文中最后注册号的最后一位数字“19”可能有误，因为在翻译中无法判断其是否准确，所以保留原样）
