Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Rheumatology (Oxford). 2024 May 2;63(5):1273-1280. doi: 10.1093/rheumatology/kead370.
Juvenile PsA (JPsA) has varied clinical features that are distinctive from other JIA categories. This study investigates whether such features impact patient-reported and clinical outcomes.
Children and young people (CYP) were selected if recruited to the Childhood Arthritis Prospective Study, a UK multicentre JIA inception cohort, between January 2001 and March 2018. At diagnosis, patient/parent-reported outcomes (as age-appropriate) included the parental global assessment (10 cm visual analogue scale), functional ability (Childhood Health Assessment Questionnaire (CHAQ)), pain (10 cm visual analogue scale), health-related quality of life (Child Health Questionnaire PF50 psychosocial score), mood/depressive symptoms (Moods and Feelings Questionnaire) and parent psychosocial health (General Health Questionnaire 30). Three-year outcome trajectories have previously been defined using active joint counts, physician and parent global assessments (PGA and PaGA, respectively). Patient-reported outcomes and outcome trajectories were compared in (i) CYP with JPsA vs other JIA categories and (ii) CYP within JPsA, with and without psoriasis via multivariable linear regression.
There were no significant differences in patient-reported outcomes at diagnosis between CYP with JPsA and non-JPsA. Within JPsA, those with psoriasis had more depressive symptoms (coefficient = 9.8; 95% CI: 0.5, 19.0) than those without psoriasis at diagnosis. CYP with JPsA had 2.3 times the odds of persistent high PaGA than other ILAR categories, despite improving joint counts and PGA (95% CI: 1.2, 4.6).
CYP with psoriasis at JPsA diagnosis report worse mood, supporting a greater disease impact in those with both skin and joint involvement. Multidisciplinary care with added focus to support wellbeing in children with JPsA plus psoriasis may help improve these outcomes.
幼年特发性关节炎（JPsA）具有与其他幼年特发性关节炎（JIA）类别不同的临床表现。本研究旨在探讨这些特征是否会影响患者报告的结局和临床结局。
如果儿童和年轻人（CYP）在 2001 年 1 月至 2018 年 3 月期间被招募到英国多中心幼年特发性关节炎发病队列的儿童关节炎前瞻性研究中，则选择其进行研究。在诊断时，患者/家长报告的结局（按年龄适当）包括家长总体评估（10cm 视觉模拟量表）、功能能力（儿童健康评估问卷（CHAQ））、疼痛（10cm 视觉模拟量表）、健康相关生活质量（儿童健康问卷 PF50 心理社会评分）、情绪/抑郁症状（情绪和感觉问卷）和家长心理健康（30 项一般健康问卷）。之前已使用活跃关节计数、医生和家长总体评估（PGA 和 PaGA）定义了 3 年结局轨迹。通过多变量线性回归比较了（i）JPsA 与其他 JIA 类别的 CYP 和（ii）JPsA 内有和无银屑病的 CYP 患者的患者报告结局和结局轨迹。
在诊断时，JPsA 和非 JPsA 的 CYP 患者的患者报告结局没有显著差异。在 JPsA 内，有银屑病的患者的抑郁症状更严重（系数=9.8；95%CI：0.5，19.0），而无银屑病的患者则更严重。尽管 JPsA 的 CYP 关节计数和 PGA 有所改善，但与其他 ILAR 类别相比，JPsA 仍有 2.3 倍的持续高 PaGA 发生几率，（95%CI：1.2，4.6）。
在 JPsA 诊断时患有银屑病的 CYP 患者报告的情绪更差，这表明那些既有皮肤又有关节受累的患者疾病影响更大。在 JPsA 合并银屑病的儿童中，多学科治疗加上对幸福感的关注可能有助于改善这些结局。
