青少年特发性关节炎-附着点相关关节炎长期功能结局的预测因素：单中心经验。
Predictors of long-term functional outcomes of juvenile idiopathic arthritis-enthesitis-related arthritis: a single centre experience.
机构信息
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
出版信息
Rheumatology (Oxford). 2023 Sep 1;62(9):3110-3116. doi: 10.1093/rheumatology/kead032.
OBJECTIVES
Long-term functional outcomes in enthesitis-related arthritis (ERA) is limited from developing countries. We assessed the clinical and genetic factors that predicted the long-term functional outcome in ERA.
METHODS
Patients with ERA having ≥5 years of disease and >16 years of age were included in this cross-sectional study. Data on clinical features within 6 months of disease onset was collected from hospital records. Bath indices, HAQ Disability Index (HAQ-DI) and World Health Organization's Quality of Life (WHO-QOL) were assessed at last visit. Poor functional outcome (PFO) was defined as BASFI > 1.5 or HAQ-DI > 1. Persistent disease activity (PDA) was defined as BASDAI ≥ 4. Endoplasmic reticulum aminopeptidase 1 (ERAP1) and IL-23 receptor single nucleotide polymorphism genotyping was performed with the TaqMan method and HLA-B27 by PCR.
RESULTS
One hundred and eighty-one patients [170 male, median (interquartile range) age of disease onset 12.5 (10-15) years, disease duration 7 (5-11) years] were recruited. There was a delay in diagnosis of 3 (1-5) years. The median Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR, BASDAI, HAQ-DI and BASFI at inclusion were 2.6 (1.8-3.6), 2.6 (1-5.2), 0.5 (0-0.5) and 1.6 (0.3-3.2), respectively. BASFI and HAQ-DI correlated with ASDAS-ESR, ASDAS-CRP and WHO-QOL-BREF. Those with PFO (n = 98) had a longer delay in diagnosis (4 vs 2 years, P < 0.001), lower prevalence of arthritis at onset [odds ratio (OR) = 0.3; 95% CI: 0.1, 0.8], higher prevalence of ERAP1 (rs27044) allele C (OR = 7.2; 95% CI: 1.5, 33.7) and higher disease activity currently. Delay in diagnosis (OR = 1.2; 95% CI: 1.08, 1.4) was the sole predictor of PFO in multivariate analysis. One-third of patients had PDA. Tarsitis at disease onset was the sole predictor of PDA (OR = 2.3; 95% CI: 1.009, 5.4).
CONCLUSIONS
PFO was seen in one-half of JIA-ERA in the long-term and was associated with active disease with delay in diagnosis as its sole predictor.
目的
来自发展中国家的附着点相关关节炎（ERA）的长期功能预后数据有限。本研究旨在评估预测 ERA 长期功能预后的临床和遗传因素。
方法
本横断面研究纳入了病程≥5 年且年龄＞16 岁的 ERA 患者。从病历中收集疾病发病后 6 个月内的临床特征数据。在最后一次就诊时评估巴斯强直性脊柱炎功能指数（BASFI）、健康评估问卷残疾指数（HAQ-DI）和世界卫生组织生活质量（WHO-QOL）。功能预后不良（PFO）定义为 BASFI＞1.5 或 HAQ-DI＞1。持续性疾病活动（PDA）定义为 BASDAI≥4。采用 TaqMan 法和聚合酶链反应（PCR）对内质网氨肽酶 1（ERAP1）和白细胞介素 23 受体单核苷酸多态性进行基因分型。
结果
共纳入 181 例患者[170 例男性，疾病发病年龄的中位数（四分位数间距）为 12.5（10-15）岁，病程为 7（5-11）年]。诊断延迟了 3（1-5）年。纳入时的平均强直性脊柱炎疾病活动度评分（ASDAS-ESR）、巴斯强直性脊柱炎疾病活动指数（BASDAI）、HAQ-DI 和 BASFI 分别为 2.6（1.8-3.6）、2.6（1-5.2）、0.5（0-0.5）和 1.6（0.3-3.2）。BASFI 和 HAQ-DI 与 ASDAS-ESR、ASDAS-CRP 和 WHO-QOL-BREF 相关。98 例 PFO 患者的诊断延迟时间更长（4 年比 2 年，P＜0.001），发病时关节炎的发生率更低（比值比（OR）=0.3；95%CI：0.1，0.8），ERAP1（rs27044）等位基因 C 的发生率更高（OR=7.2；95%CI：1.5，33.7），目前疾病活动度更高。多变量分析显示，诊断延迟（OR=1.2；95%CI：1.08，1.4）是 PFO 的唯一预测因素。三分之一的患者存在 PDA。发病时的跟腱炎是 PDA 的唯一预测因素（OR=2.3；95%CI：1.009，5.4）。
结论
在长期随访中，JIA-ERA 中有一半患者出现 PFO，与疾病活动度相关，其唯一预测因素是诊断延迟。
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