Faculty of Medicine and Life Science, Tampere University, Tampere, Finland.
Päijät-Häme Joint Authority for Health and Wellbeing, Terveystie 4, 15870, Lahti, Hollola, Finland.
Clin Rheumatol. 2020 Mar;39(3):853-860. doi: 10.1007/s10067-019-04804-x. Epub 2019 Nov 16.
Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumonia due to modern disease-modifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with JIA.
Patients under 18 years of age with JIA and pneumonia during 1998-2014 were identified in the National Hospital Discharge Register in Finland. Each individual patient record was reviewed, and detailed data on patients with JIA and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious.
There were 157 episodes of pneumonia among 140 children with JIA; 111 episodes (71%) were serious (80% in 1998-2006 and 66% in 2007-2014). The mean age of the patients was 9 years. Forty-eight percent had active JIA and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (DMARD) were used at the time of 135 episodes (86%): methotrexate (MTX) by 62% and biologic DMARDs (bDMARD) by 30%. There was no significant difference in the use of bDMARDs, MTX and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully.
Although the incidence of pneumonia and the use of immunosuppressive treatment among children with JIA increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia.Key Points• The incidence of serious pneumonias decreased from 1998 to 2014 among children with juvenile idiopathic arthritis (JIA).• There was no significant difference in the use of the disease-modifying anti-rheumatic medication between JIA patients with serious and non-serious pneumonias.• Active JIA, comorbidities, and combination medication were associated with nearly half of the pneumonias.
由于现代的疾病修饰抗风湿治疗，幼年特发性关节炎（JIA）患儿可能易患严重肺炎。在这项具有临床数据的全国性回顾性研究中，我们描述了 JIA 患儿的肺炎发作情况。
在芬兰国家住院患者登记处，确定了 1998 年至 2014 年间患有 JIA 和肺炎的 18 岁以下患者。对每位患者的病历进行了审查，并检索、记录和分析了 JIA 患儿的详细肺炎数据。如果患者住院或接受静脉抗生素治疗，则认为肺炎严重。
在 140 名患有 JIA 的儿童中，共发生了 157 例肺炎发作；其中 111 例（71%）为严重肺炎（1998-2006 年为 80%，2007-2014 年为 66%）。患者的平均年龄为 9 岁。48%的患者有活动期 JIA，46%的患者有合并症。在 135 例发作时使用了疾病修饰抗风湿药物（DMARD）（86%）：62%的患者使用甲氨蝶呤（MTX），30%的患者使用生物 DMARD（bDMARD）。严重和非严重肺炎发作患者组之间 bDMARD、MTX 和糖皮质激素的使用无显著差异。在 6 例发作中需要重症监护。两名患者（1.3%）死亡，其余患者完全康复。
尽管 1998 年至 2014 年期间 JIA 患儿肺炎的发病率和免疫抑制治疗的使用有所增加，但这些患者严重肺炎的比例有所下降。严重和非严重肺炎发作的 JIA 患者之间使用抗风湿药物无显著差异。
