4th Department of Internal Medicine, School of Medicine, Rheumatology Unit, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
1st Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Centre, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Rheumatol Int. 2020 Jun;40(6):941-949. doi: 10.1007/s00296-020-04581-w. Epub 2020 Apr 22.
To describe the profile of Enthesitis Related Arthritis' (ERA) patients, in the era of biologic DMARDs (bDMARDs). This retrospective cohort study included patients with ERA monitored on a 3-month schedule for at least 1 year. Their metric assessment included the disease status and damage by applying the contemporary tools clinical-Juvenile Arthritis Disease Activity Score (c-JADAS), Juvenile Spondyloarthritis Disease Activity Index (JSpADA), clinical remission (CR) on/off medication and Juvenile Arthritis Damage Index (JADI). 43 patients (males 26) were enrolled, with a mean disease onset of 10.75 years. Median lag time from diagnosis to bDMARDs was 8.5 months. Patients with sacroiliitis received earlier bDMARDs (hazard ratio, HR 3.26). 36/43 patients achieved CR on medication (median time 11 months), which was correlated with compliance (HR: 3.62). The percentage of CR in patients with or without sacroiliitis was 35% and 63% respectively (p = 0.02). Twenty patients (47%) experienced a flare following CR (75%). The median flare-free survival following CR on/off medication was 42 and 34 months, respectively. At the last evaluation, both median baseline cJADAS and JSpADA dropped to 0, 13/43 patients had a persistent disease activity, while 17/43 and 13/43 patients were in CR on/off medication, respectively. The median patient percentage of CR was 54% and no patient had a JADI > 0. Increased lag time to bDMARDs was associated with increased CR (Odds ratio: 1.48). Early administration of bDMARDs and compliance improved long-term outcome of ERA. Sacroiliitis was a negative prognostic factor with an increased need for bDMARDs and diminished rates of CR.
描述生物制剂时代（bDMARDs）下附着点相关关节炎（ERA）患者的特征。本回顾性队列研究纳入了至少接受了 1 年每 3 个月随访的 ERA 患者。采用临床幼年特发性关节炎疾病活动度评分（c-JADAS）、幼年脊柱关节炎疾病活动指数（JSpADA）、停药和用药时临床缓解（CR）以及幼年关节炎损伤指数（JADI）等现代工具对疾病状态和损害进行评估。共纳入 43 例患者（男 26 例），平均发病年龄为 10.75 岁。从确诊到使用 bDMARDs 的中位时间间隔为 8.5 个月。存在骶髂关节炎的患者更早接受 bDMARDs（风险比，HR 3.26）。43 例患者中有 36 例（中位数时间为 11 个月）达到了用药时的 CR，与依从性相关（HR：3.62）。有或无骶髂关节炎患者的 CR 百分比分别为 35%和 63%（p=0.02）。20 例（47%）在达到 CR 后出现了疾病复发（75%）。停药和用药时 CR 后无复发的中位生存时间分别为 42 和 34 个月。末次评估时，cJADAS 和 JSpADA 的基线中位数均降至 0，13/43 例患者仍存在疾病活动，而 17/43 和 13/43 例患者停药和用药时分别处于 CR。CR 患者的中位数百分比为 54%，无患者的 JADI>0。bDMARDs 治疗延迟与 CR 增加相关（比值比：1.48）。bDMARDs 的早期应用和依从性改善了 ERA 的长期预后。骶髂关节炎是一个不良预后因素，需要更早使用 bDMARDs，CR 率降低。
