Department of Pediatrics, University of British Columbia.
British Columbia Children's Hospital, Vancouver, British Columbia.
Rheumatology (Oxford). 2020 Dec 1;59(12):3727-3730. doi: 10.1093/rheumatology/keaa118.
To assess long-term outcomes of children with JIA diagnosed in the biologic era.
Chart review of patients prospectively enrolled in the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort at two Canadian centres. Inactive disease and remission were defined according to Wallace criteria.
We included 247 of 254 (97%) eligible patients diagnosed 2005-10. At the last follow-up visit at a median age of 16.9 years, 47% were in remission off medications, 25% in remission on medications and 27% had active disease; 51% were on at least one anti-rheumatic medication (22% on biologics). Patients with systemic JIA had the highest frequency of remission off medications (70%) and patients with RF-positive polyarthritis had the lowest (18%) (P <0.05 by Fisher's exact test). Among 99 patients with oligoarthritis at enrolment, 14 (14%) had an oligoarthritis extended course. Forty-five patients (18%) had at least one erosion or joint space narrowing in X-rays or MRI, and two (0.8%) required joint replacement.
Relative to historical cohorts, this study suggests a reduction in JIA permanent damage, a more favourable prognosis for systemic JIA and a lower progression to oligoarthritis extended category. However, in an era of biologic therapy, one in four patients with JIA still enter adulthood with active disease and one in two still on treatment.
评估生物制剂时代诊断的幼年特发性关节炎（JIA）患儿的长期结局。
对在加拿大两个中心前瞻性入组的加拿大儿童关节炎研究中强调结局的研究队列中的患者进行图表回顾。根据 Wallace 标准定义疾病缓解和无活动。
我们纳入了 2005-10 年诊断的 254 名符合条件患者中的 247 名。在中位数年龄为 16.9 岁的最后一次随访时，47%的患者停药后缓解，25%的患者在药物治疗下缓解，27%的患者疾病活动；51%的患者至少使用一种抗风湿药物（22%使用生物制剂）。全身型 JIA 患者停药后缓解率最高（70%），RF 阳性多关节炎患者缓解率最低（18%）（Fisher 确切检验，P<0.05）。在入组时患有少关节炎的 99 名患者中，14 名（14%）为少关节炎扩展型病程。45 名患者（18%）在 X 线或 MRI 上至少有一处侵蚀或关节间隙变窄，2 名（0.8%）需要关节置换。
与历史队列相比，本研究表明 JIA 永久性损害减少，全身型 JIA 预后较好，少关节炎扩展型病程进展减少。然而，在生物治疗时代，仍有四分之一的 JIA 患者成年后仍有疾病活动，二分之一的患者仍在接受治疗。
