Glerup Mia, Arnstad Ellen D, Rypdal Veronika, Peltoniemi Suvi, Aalto Kristiina, Rygg Marite, Nielsen Susan, Fasth Anders, Berntson Lillemor, Nordal Ellen, Herlin Troels
Aarhus University Hospital, Aarhus, Denmark.
Norwegian University of Science and Technology, Trondheim, Norway, and Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Arthritis Care Res (Hoboken). 2022 May;74(5):719-727. doi: 10.1002/acr.24857. Epub 2022 Mar 15.
To explore sustainability of achieved remission off medication and defined International League of Associations for Rheumatology (ILAR) categories in juvenile idiopathic arthritis (JIA) and describe the trajectory of disease course over time by comparing treatment, disease activity, and ILAR categories from baseline, 8 years, and 18 years after disease onset.
A total of 373 of the 510 included patients were initially recruited consecutive cases of JIA from the prospective, longitudinal, population-based Nordic JIA cohort with disease onset during 1997-2000 from Denmark, Norway, Sweden, and Finland in an 18-year follow-up study. Clinical data were collected consecutively at baseline, 8 years, and 18 years after disease onset and were evaluated regarding treatment, disease activity, and ILAR category.
Significantly more patients (70%) were off medication after 18 years of follow-up compared to after 8 years (59.7%); nevertheless, the number of patients in remission had not increased (52% off medication versus 51% on medication). Twelve percent of patients changed ILAR category between 8 years and 18 years after disease onset. Almost half of the changes were due to updated information about heredity in a first-degree relative. In the same period, the psoriatic arthritis group increased significantly in number (P < 0.001), in contrast to the oligoarticular category, which decreased (P = 0.02). The undifferentiated group increased 24% from 8 to 18 years of follow-up; however, this increase was not significant (P = 0.06).
In this Nordic JIA cohort study, the remission rate did not increase even though significantly more patients were off medication at the 18-year follow-up compared to at the 8-year follow-up after disease onset. The distribution of patients in the ILAR categories continued to change significantly throughout the 18-year study period.
探讨青少年特发性关节炎（JIA）患者停药后缓解状态的可持续性以及国际风湿病联盟（ILAR）分类情况，并通过比较疾病发作后基线、8年和18年时的治疗、疾病活动度及ILAR分类，描述疾病进程随时间的变化轨迹。
在一项为期18年的随访研究中，从丹麦、挪威、瑞典和芬兰的前瞻性、纵向、基于人群的北欧JIA队列中，最初连续招募了510例JIA患者中的373例，其疾病发作时间在1997 - 2000年。在疾病发作后的基线、8年和18年连续收集临床数据，并对治疗、疾病活动度和ILAR分类进行评估。
与8年随访后（59.7%）相比，18年随访后停药的患者显著增多（70%）；然而，缓解患者的数量并未增加（停药患者占52%，服药患者占51%）。12%的患者在疾病发作后8年至18年期间改变了ILAR分类。几乎一半的分类改变是由于一级亲属遗传信息的更新。同期，银屑病关节炎组的患者数量显著增加（P < 0.001），而少关节型组患者数量减少（P = 0.02）。未分化型组在8年至18年随访期间增加了24%；然而，这一增加并不显著（P = 0.06）。
在这项北欧JIA队列研究中，尽管与疾病发作后8年随访相比，18年随访时停药的患者显著增多，但缓解率并未提高。在整个18年的研究期间，患者在ILAR分类中的分布持续发生显著变化。
