泰国青少年特发性关节炎患儿的残疾和疾病相关损伤。
Disability and disease-related damage in Thai children and adolescents with juvenile idiopathic arthritis.
机构信息
Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
出版信息
Pediatr Rheumatol Online J. 2023 Jul 10;21(1):68. doi: 10.1186/s12969-023-00852-5.
BACKGROUND
Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from disability and disease-related damage. This study aimed to investigate the prevalence of disability and damage, and identify the factors associated with articular and extra-articular damage in children and adolescents with JIA in a resource-restricted setting in Thailand.
METHODS
This cross-sectional study enrolled JIA patients during June 2019-June 2021. Disability was assessed using the Child Health Assessment Questionnaire (CHAQ) and Steinbrocker classification criteria. Damage was evaluated using the Juvenile Arthritis Damage Index (JADI) and the modified-JADI (mJADI) tools.
RESULTS
There were 101 patients (50.5% female) with median age of 11.8 years. Median disease duration was 32.7 months. Enthesitis-related arthritis (ERA) was the most common subtype (33.7%), followed by systemic JIA (25.7%). Thirty-three (32.7%) patients had delayed diagnosis ≥ 6 months. Moderate to severe disability was found in 20 (19.8%) patients. Patients with Steinbrocker functional classification > class I were seen in 17.9%. Thirty-seven (36.6%) patients had articular damage. Extra-articular complications were observed in 24.8%. Growth failure and striae were the most common complications in 7.8%. Leg-length discrepancy was documented in 5.0%. Ocular damage was found in 1 patient with ERA. Multivariable logistic regression analysis revealed Steinbrocker functional classification > class I (aOR: 18.1, 95% CI: 3.9-84.6; p < 0.001), delayed diagnosis ≥ 6 months (aOR: 8.5, 95%CI: 2.7-27.0; p < 0.001), and ERA (aOR: 5.7, 95%CI: 1.8-18.3; p = 0.004) as independent predictors of articular damage. Systemic corticosteroids use was the independent predictor of extra-articular damage (aOR: 3.8, 95%CI: 1.3-11.1; p = 0.013).
CONCLUSIONS
Disability and disease-related damage was identified in one-fifth and one-third of JIA patients. Early detection and treatment are essential for preventing permanent damage.
背景
幼年特发性关节炎（JIA）患儿可能存在残疾和与疾病相关的损伤。本研究旨在探讨资源匮乏的泰国儿童和青少年 JIA 患者的残疾和损伤发生率，并确定与关节和关节外损伤相关的因素。
方法
这是一项横断面研究，于 2019 年 6 月至 2021 年 6 月期间招募了 JIA 患者。使用儿童健康评估问卷（CHAQ）和 Steinbrocker 分类标准评估残疾，使用幼年特发性关节炎损伤指数（JADI）和改良-JADI（mJADI）工具评估损伤。
结果
共纳入 101 例（50.5%为女性）患者，中位年龄为 11.8 岁。中位疾病病程为 32.7 个月。附着点炎相关关节炎（ERA）是最常见的亚型（33.7%），其次是全身型 JIA（25.7%）。33 例（32.7%）患者的诊断延迟≥6 个月。20 例（19.8%）患者存在中重度残疾。Steinbrocker 功能分类>Ⅰ级的患者占 17.9%。37 例（36.6%）患者存在关节损伤。24.8%的患者存在关节外并发症。7.8%的患者出现生长迟缓、萎缩纹。5.0%的患者存在肢体长度差异。1 例 ERA 患者出现眼部损伤。多变量逻辑回归分析显示，Steinbrocker 功能分类>Ⅰ级（优势比：18.1，95%可信区间：3.9-84.6；p<0.001）、诊断延迟≥6 个月（优势比：8.5，95%可信区间：2.7-27.0；p<0.001）和 ERA（优势比：5.7，95%可信区间：1.8-18.3；p=0.004）是关节损伤的独立预测因素。全身皮质类固醇的使用是关节外损伤的独立预测因素（优势比：3.8，95%可信区间：1.3-11.1；p=0.013）。
结论
JIA 患者有五分之一存在残疾，三分之一存在与疾病相关的损伤。早期发现和治疗对于预防永久性损伤至关重要。
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