Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster.
Epidemiology Unit, German Rheumatism Research Center, Berlin, Germany.
Rheumatology (Oxford). 2022 Nov 28;61(12):4975-4984. doi: 10.1093/rheumatology/keac178.
JIA is characterised by a chronic disease course. Once patients achieve a state of inactive disease, there are no established biomarkers to predict the further course of inflammation for these patients. Therefore, the purpose of this study was to quantify serum biomarkers during quiescent disease to evaluate their use in identifying JIA patients at risk for future disease flare.
Patients with non-systemic JIA reaching inactive disease status were divided into two groups: 92 patients with future active disease after a median period of 6 months (range 3-9) and 80 patients with persistent inactive disease for the following period (median 11 months, range 7-16) according to the juvenile arthritis DAS (JADAS). Clinical parameters and serum levels of various biomarkers were measured in the state of inactive disease using immunoassays in both groups and were analysed for their potential to predict the further course of disease.
Soluble interleukin-2 receptor (sIL-2R) serum levels were significantly higher in patients with future active disease (P = 0.021), which especially applied to patients with RF-negative polyarticular and extended oligoarticular JIA (P < 0.001). Higher sIL-2R serum levels during inactive disease were associated with a greater number of active joints at future active disease.
Patients without clinical signs of disease activity already presented with increased sIL-2R serum levels several months before disease relapses, whereas conventional inflammation parameters were not elevated. Determination of sIL-2R serum levels during inactive disease may facilitate identifying patients with subclinical disease activity at risk for future active disease.
幼年特发性关节炎（JIA）以慢性疾病过程为特征。一旦患者达到疾病缓解状态，目前尚没有确定的生物标志物来预测这些患者炎症的进一步发展。因此，本研究的目的是量化缓解期患者的血清生物标志物，以评估其在识别有未来疾病复发风险的 JIA 患者中的作用。
将达到缓解状态的非系统性 JIA 患者分为两组：92 例患者在中位数为 6 个月（范围 3-9 个月）的时间后出现活动性疾病（范围 3-9），80 例患者在随后的时间内持续处于缓解状态（中位数为 11 个月，范围 7-16 个月），根据幼年特发性关节炎疾病活动度评分（JADAS）。使用免疫测定法在两组患者缓解期时测量各种生物标志物的临床参数和血清水平，并分析其预测疾病进一步发展的潜力。
未来出现活动性疾病的患者可溶性白细胞介素 2 受体（sIL-2R）血清水平显著升高（P=0.021），这尤其适用于 RF 阴性多关节型和扩展寡关节型 JIA 患者（P<0.001）。缓解期 sIL-2R 血清水平较高与未来活动性疾病时更多的活跃关节相关。
在疾病复发前数月，无临床疾病活动迹象的患者已经出现 sIL-2R 血清水平升高，而常规炎症参数并未升高。在缓解期测定 sIL-2R 血清水平可能有助于识别有未来发生活动性疾病风险的亚临床疾病活动患者。
