Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Bilkent, Ankara, Turkey.
Eur J Pediatr. 2023 Oct;182(10):4557-4564. doi: 10.1007/s00431-023-05123-9. Epub 2023 Aug 1.
The aim of this study was to evaluate the predictors of relapse in patients with oligoarticular juvenile idiopathic arthritis (oJIA) who achieved clinical remission off medication. This retrospective observational study was conducted between June 2009 and July 2022 in 126 patients with oJIA who achieved remission off medication. The relationships between relapse status and demographic, clinical and laboratory findings, and treatment details were evaluated using electronic medical records. Of the 126 oJIA patients who achieved remission off medication, 85 (67.5%) were female. Relapse occurred in 31 patients (24.6%) with remission off medication after a median of 18 months (IQR 7-26). No statistically significant relationship was found between gender, age at diagnosis, oJIA subtype, number of joints, ANA, ESR, CRP level, initial Juvenile Arthritis Disease Activity Score and relapse in oJIA patients who achieved remission off medication (p = 0.66, p = 0.25, p = 1, p = 0.54, p = 0.29, p = 0.59, p = 0.95 and p = 0.52, respectively). There was a statistically significant relationship between the number of intraarticular corticosteroid injections (IACIs) and relapse (p = 0.01). Patients who underwent IACI 2-3 times had more relapses than those who never underwent IACI and those who underwent IACI only once (p = 0.01, p = 0.02, respectively). A relationship was found between the length of follow-up and relapse in patients with oJIA who achieved remission off medication (p = 0.035). Conclusion: In oJIA patients who achieve remission off medication, the probability of relapse increases in patients who need ≥ 2 IACI during the period until remission. The length of follow-up period is associated with the probability of relapse. What is Known: • Approximately one-fourth of oJIA patients who are in remission off medication have relapse. • There is a need for markers that can predict the risk of relapse in oJIA patients who achieve remission on or off medication. What is New: • The possibility of relapse should be considered in patients with oJIA who need ≥ 2 IACIs until achieving remission off medication. • The relapse rate may increase as the follow-up period prolongs in patients who achieve remission off medication.
这项研究的目的是评估达到药物缓解的寡关节炎型幼年特发性关节炎（oJIA）患者复发的预测因素。这项回顾性观察性研究于 2009 年 6 月至 2022 年 7 月在 126 例达到药物缓解的 oJIA 患者中进行。使用电子病历评估复发状态与人口统计学、临床和实验室发现以及治疗细节之间的关系。在 126 例达到药物缓解的 oJIA 患者中，85 例（67.5%）为女性。缓解后中位数 18 个月（IQR 7-26）时 31 例（24.6%）患者复发。在达到药物缓解的 oJIA 患者中，性别、诊断时年龄、oJIA 亚型、关节数、ANA、ESR、CRP 水平、初始幼年特发性关节炎疾病活动评分与复发之间无统计学显著关系（p=0.66，p=0.25，p=1，p=0.54，p=0.29，p=0.59，p=0.95，p=0.52）。关节内皮质类固醇注射（IACI）的次数与复发之间存在统计学显著关系（p=0.01）。接受 2-3 次 IACI 的患者比从未接受 IACI 或仅接受 1 次 IACI 的患者更易复发（p=0.01，p=0.02）。在达到药物缓解的 oJIA 患者中，随访时间与复发之间存在关系（p=0.035）。结论：在达到药物缓解的 oJIA 患者中，在达到缓解期间需要接受≥2 次 IACI 的患者复发的可能性增加。随访时间与复发的可能性有关。已知：oJIA 患者中有四分之一在药物缓解后会复发。需要有可以预测在药物缓解或不缓解的 oJIA 患者中复发风险的标志物。新发现：在达到药物缓解的 oJIA 患者中，需要接受≥2 次 IACI 才能达到缓解的患者应考虑复发的可能性。在达到药物缓解的患者中，随着随访时间的延长，复发率可能会增加。
