Alfayadh Naba M, Gowdie Peter J, Akikusa Jonathan D, Easton Mee Lee, Buttery Jim P
Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
Departments of General Paediatrics and Paediatric Rheumatology, Monash Children's Hospital, Clayton, Melbourne, Victoria, Australia.
Int J Rheumatol. 2020 Aug 4;2020:1078914. doi: 10.1155/2020/1078914. eCollection 2020.
Juvenile idiopathic arthritis (JIA) is a collective term for a group of inflammatory conditions of uncertain origin, which causes chronic arthritis in one or more joints. The clinical course of JIA is characterised by episodes of increased activity, termed flares. Vaccinations have previously been proposed as a "trigger" for some flares, although evidence supporting this is scant.
To explore whether routine childhood vaccinations are associated with an increased risk of flares of arthritis activity in children with JIA.
Patients aged below 6 years with a diagnosis of JIA were recruited from the Rheumatology Clinical Database at the Royal Children's Hospital, Melbourne, Australia, from 1 January 2010 to 30 April 2016. Patient immunisation status was cross-checked with the Australian Childhood Immunisation Register (ACIR). The self-controlled case series methodology (Rowhani-Rahbar et al., 2012) was applied to determine whether the risk of arthritis flares in the three months following immunisation was greater than the baseline risk for each patient.
138 patients were included in the study. 32 arthritis flares occurred in the 90 days following immunisation. The risk of arthritis flares during the 90 days following immunisation was reduced compared with patients' baseline risk (RR 0.59 (95% CI 0.39-0.89, = 0.012)).
Routine childhood immunisations were not associated with arthritis flare onset in patients with JIA. The risk of arthritis flares in the 90 days following vaccination was lower than the baseline risk. In the context of COVID19, vaccination will not increase interaction with the healthcare system beyond the immunisation encounter.
幼年特发性关节炎（JIA）是一组病因不明的炎症性疾病的统称，可导致一个或多个关节的慢性关节炎。JIA的临床病程以活动增加期（称为病情复发）为特征。以前有人提出疫苗接种是某些病情复发的“触发因素”，但支持这一观点的证据很少。
探讨儿童常规疫苗接种是否与JIA患儿关节炎活动病情复发风险增加有关。
2010年1月1日至2016年4月30日期间，从澳大利亚墨尔本皇家儿童医院的风湿病临床数据库中招募了6岁以下诊断为JIA的患者。患者的免疫状况与澳大利亚儿童免疫登记册（ACIR）进行了交叉核对。采用自身对照病例系列方法（Rowhani-Rahbar等人，2012年）来确定免疫接种后三个月内关节炎病情复发的风险是否高于每位患者的基线风险。
138名患者纳入研究。免疫接种后90天内发生了32次关节炎病情复发。与患者的基线风险相比，免疫接种后90天内关节炎病情复发的风险降低（相对风险0.59（95%可信区间0.39 - 0.89，P = 0.012））。
儿童常规免疫接种与JIA患者的关节炎病情复发无关。接种疫苗后90天内关节炎病情复发的风险低于基线风险。在2019冠状病毒病的背景下，接种疫苗不会增加除免疫接种接触之外与医疗保健系统的接触。
