Udaondo Clara, Núñez Cuadros Esmeralda, Murias Sara, Remesal Agustin, Alcobendas Rosa, Guerrero Concepción, Guillen-Martin Sara, Escuredo Marta, Aleo Esther, Alonso Daniel, Tagarro Alfredo, De Santiago Eloisa, Camacho-Lovillo Marisol, Diaz Fatima, Arenas Dolores, Camacho Pilar, Lirola Maria Jose, Díaz Almirón Mariana, Calvo Cristina
Pediatric Rheumatology Unit, University Hospital La Paz, Madrid, Spain.
La Paz Research Institute (IDIPaz), Madrid, Spain.
Front Pediatr. 2022 Aug 11;10:917731. doi: 10.3389/fped.2022.917731. eCollection 2022.
Children with juvenile idiopathic arthritis (JIA) might be at a higher risk of infection. Our objectives are to describe and compare infection rates in patients with JIA vs. healthy patients.
A prospective, multicenter observational study was performed in Spain from January 2017 to June 2019. Patients with JIA from 7 participating hospitals and children without JIA (siblings of patients with JIA, and non-JIA children from primary health centers) were followed up with quarterly questionnaires to record infection episodes. Tuberculosis, herpes zoster, and infections requiring hospital admission were considered severe infections. Rates of infection (episodes/patient/year) were compared using a generalized estimating equations model.
A total of 371 children (181 with and 190 without JIA) were included. The median age was 8.8 years (IQR 5.5-11.3); 75% of the patients with JIA received immunosuppressive treatment (24% methotrexate, 22% biologic, 26% both). A total of 667 infections were recorded; 15 (2.2%) were considered severe. The infection rate was 1.31 (95%CI 1.1-1.5) in JIA and 1.12 (95%CI 0.9-1.3) in non-JIA participants ( = 0.19). Age <4 years increased the infection rate by 2.5 times (2.72 vs. 1.12, < 0.001) in both groups. The most frequent infection sites were upper respiratory (62.6% vs. 74.5%) and gastrointestinal (18.8% vs. 11.4%). There were no differences in severe infections (2.5% vs. 2%, = 0.65) between the groups. In children with JIA, younger age and higher disease activity (JADAS71) were associated with a higher infection rate.
We found no differences in the infection rate or infection severity between patients with and without JIA. Most infections were mild. An age younger than 4 years increased the infection risk in both groups. Higher disease activity was associated with a higher infection rate.
幼年特发性关节炎（JIA）患儿可能有更高的感染风险。我们的目的是描述和比较JIA患者与健康患者的感染率。
2017年1月至2019年6月在西班牙进行了一项前瞻性、多中心观察性研究。对来自7家参与研究医院的JIA患者以及无JIA的儿童（JIA患者的兄弟姐妹和初级卫生保健中心的非JIA儿童）每季度进行问卷调查，以记录感染事件。结核病、带状疱疹以及需要住院治疗的感染被视为严重感染。使用广义估计方程模型比较感染率（事件数/患者/年）。
共纳入371名儿童（181名JIA患儿和190名非JIA患儿）。中位年龄为8.8岁（四分位间距5.5 - 11.3）；75%的JIA患者接受免疫抑制治疗（24%使用甲氨蝶呤，22%使用生物制剂，26%两者都用）。共记录到667次感染；15次（2.2%）被视为严重感染。JIA患者的感染率为1.31（95%置信区间1.1 - 1.5），非JIA参与者的感染率为1.12（95%置信区间0.9 - 1.3）（P = 0.19）。两组中年龄<4岁者感染率增加2.5倍（2.72对1.12，P < 0.001）。最常见的感染部位是上呼吸道（62.6%对74.5%）和胃肠道（18.8%对11.4%）。两组间严重感染无差异（2.5%对2%，P = 0.65）。在JIA患儿中，年龄较小和疾病活动度较高（JADAS71）与较高的感染率相关。
我们发现JIA患者与非JIA患者在感染率或感染严重程度方面没有差异。大多数感染为轻度。年龄小于4岁会增加两组的感染风险。较高的疾病活动度与较高的感染率相关。
