Aarhus University Hospital, Aarhus, Denmark.
University Hospital of North Norway and UiT - The Arctic University of Norway, Tromsø, Norway.
Arthritis Care Res (Hoboken). 2020 Apr;72(4):507-516. doi: 10.1002/acr.23853.
The present study was undertaken to assess the long-term course, remission rate, and disease burden in juvenile idiopathic arthritis (JIA) 18 years after disease onset in a population-based setting from the early biologic era.
A total of 510 consecutive cases of JIA with disease onset between 1997 and 2000 from defined geographic regions in Denmark, Norway, Sweden, and Finland were prospectively included in this 18-year cohort study. At the follow-up visit, patient-reported demographic and clinical data were collected.
The study included 434 (85%) of the 510 eligible JIA participants. The mean ± SD age was 24.0 ± 4.4 years. The median juvenile arthritis disease activity score in 71 joints (JADAS-71) was 1.5 (interquartile range [IQR] 0-5), with the enthesitis-related arthritis (ERA) category of JIA having the highest median score (4.5 [IQR 1.5-8.5], P = 0.003). In this cohort, 46% of patients still had active disease, and 66 (15%) were treated with synthetic disease-modifying antirheumatic drugs and 84 (19%) with biologics. Inactive disease indicated by a JADAS-71 score of <1 was seen in 48% of participants. Clinical remission off medication (CR) was documented in 33% of the participants with high variability among the JIA categories. CR was most often seen in persistent oligoarticular and systemic arthritis and least often in ERA (P < 0.001).
A substantial proportion of the JIA cohort did not achieve CR despite new treatment options during the study period. The ERA category showed the worst outcomes, and in general there is still a high burden of disease in adulthood for JIA.
本研究旨在评估丹麦、挪威、瑞典和芬兰特定地理区域内的生物制剂早期时代，发病 18 年后幼年特发性关节炎（JIA）的长期病程、缓解率和疾病负担。
本 18 年队列研究前瞻性纳入了 510 例发病于 1997 年至 2000 年的丹麦、挪威、瑞典和芬兰 JIA 患者，所有患者均连续入组。在随访时，收集患者报告的人口统计学和临床数据。
本研究共纳入 510 例符合条件的 JIA 患者中的 434 例（85%）。平均年龄为 24.0±4.4 岁。71 个关节的幼年关节炎疾病活动评分（JADAS-71）中位数为 1.5（四分位距 [IQR] 0-5），其中附着点相关关节炎（ERA）分类的 JIA 评分最高（4.5 [IQR 1.5-8.5]，P=0.003）。在该队列中，46%的患者仍存在疾病活动，66 例（15%）患者接受了合成疾病修饰抗风湿药物治疗，84 例（19%）患者接受了生物制剂治疗。48%的患者达到 JADAS-71 评分<1，表明疾病处于不活动状态。33%的患者实现了停药的临床缓解（CR），不同 JIA 分类之间存在很大的差异。持续性少关节炎和全身型关节炎患者中 CR 最常见，而 ERA 患者中 CR 最不常见（P<0.001）。
尽管在研究期间有了新的治疗选择，但 JIA 队列中仍有相当大比例的患者未达到 CR。ERA 分类的结局最差，总体而言，JIA 患者成年后仍存在较高的疾病负担。
