Hendry Gordon J, Shoop-Worrall Stephanie J, Riskowski Jody L, Andrews Pamela, Baildam Eileen, Chieng Alice, Davidson Joyce, Ioannou Yiannis, McErlane Flora, Wedderburn Lucy R, Hyrich Kimme, Thomson Wendy, Steultjens Martijn
School of Health & Life Sciences, Glasgow Caledonian University, Glasgow.
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester.
Rheumatol Adv Pract. 2018;2(2):rky039. doi: 10.1093/rap/rky039. Epub 2018 Nov 24.
The aim was to investigate the time course of lower limb disease activity and walking disability in children with JIA over a 5-year course.
The Childhood Arthritis Prospective Study is a longitudinal study of children with a new JIA diagnosis. Childhood Arthritis Prospective Study data include demographics and core outcome variables at baseline, 6 months and yearly thereafter. Prevalence and transition rates from baseline to 5 years were obtained for active and limited joint counts at the hip, knee, ankle and foot joints; and walking disability, measured using the Childhood Health Assessment Questionnaire walking subscale. Missing data were accounted for using multiple imputation.
A total of 1041 children (64% female), with a median age of 7.7 years at first visit, were included. Baseline knee and ankle synovitis prevalence was 71 and 34%, respectively, decreasing to 8-20 and 6-12%, respectively, after 1 year. Baseline hip and foot synovitis prevalence was <11%, decreasing to <5% after 6 months. At least mild walking disability was present in 52% at baseline, stabilizing at 25-30% after 1 year.
Lower limb synovitis and walking disability are relatively common around the time of initial presentation in children and young people with JIA. Mild to moderate walking disability persisted in ∼25% of patients for the duration of the study, despite a significant reduction in the frequency of lower limb synovitis. This suggests that there is an unmet need for non-medical strategies designed to prevent and/or resolve persistent walking disability in JIA.
旨在研究幼年特发性关节炎（JIA）患儿5年病程中下肢疾病活动度和行走功能障碍的时间进程。
儿童关节炎前瞻性研究是一项针对新诊断为JIA的儿童的纵向研究。儿童关节炎前瞻性研究数据包括基线、6个月及之后每年的人口统计学和核心结局变量。获取了从基线到5年期间髋、膝、踝和足部关节的活动关节计数和受限关节计数的患病率及转换率；以及使用儿童健康评估问卷步行子量表测量的行走功能障碍情况。采用多重填补法处理缺失数据。
共纳入1041名儿童（64%为女性），首次就诊时的中位年龄为7.7岁。基线时膝关节和踝关节滑膜炎的患病率分别为71%和34%，1年后分别降至8 - 20%和6 - 12%。基线时髋关节和足部滑膜炎的患病率<11%，6个月后降至<5%。基线时至少有轻度行走功能障碍的患儿占52%，1年后稳定在25 - 30%。
在JIA儿童和青少年初次就诊时，下肢滑膜炎和行走功能障碍相对常见。尽管下肢滑膜炎的频率显著降低，但在研究期间仍有约25%的患者持续存在轻度至中度行走功能障碍。这表明对于旨在预防和/或解决JIA患者持续性行走功能障碍的非药物策略存在未满足的需求。
