Department of Woman, Mother, Child, Unit of Pediatric Immunology, Allergology and Rheumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Pediatrics, Unit of Rheumatology and Nephrology, Mother and Child University Hospital A. Harouchi, CHU Ibn Rochd, Casablanca, Morocco.
Pediatr Rheumatol Online J. 2023 Sep 7;21(1):96. doi: 10.1186/s12969-023-00886-9.
Systemic juvenile idiopathic arthritis (systemic JIA) is a severe disease with both systemic and joint inflammation. This study aims to identify predictors of disease evolution within the systemic JIA population enrolled in the Juvenile Inflammatory Rheumatism cohort (JIRcohort).
Observational patient cohort study with 201 recruited children from 4 countries (3 European, 1 North Africa) from 2005 until 2019, using retrospectively (2005-2015) and prospectively (2015-2019) routine care collected data.
Sixty-five patients with complete follow-up data for 24 months after first diagnosis were classified as monophasic (n = 23), polyphasic (n = 6) or persistent group (n = 36) corresponding to their evolution (unique flare, recurrent flares, or persistent disease activity respectively). The patients of the persistent group were more likely to have an earlier disease onset, before the age of 6 (OR 2.57, 95%-CI 0.70-9.46), persistence of arthritis at 12-months post-diagnosis (OR 4.45, 95%-CI 0.58-34.20) and higher use of synthetic DMARD (sDMARD, OR 5.28, 95%-CI 1.39-20.01). Other variables like global assessment by physician and by patient and C Reactive Protein levels at 12-months post-diagnosis were assessed but without any predictive value after adjusting for confounding factors.
Our results suggest that the earlier disease onset, the persistence of arthritis throughout the first year of disease evolution and the need of sDMARD might predict a persistent disease course.
全身性幼年特发性关节炎（systemic JIA）是一种严重的疾病，既有全身炎症又有关节炎症。本研究旨在确定纳入幼年炎症性风湿病队列（JIRcohort）的全身性 JIA 人群中疾病演变的预测因素。
这是一项观察性患者队列研究，共纳入了来自 4 个国家（3 个欧洲国家，1 个北非国家）的 201 名儿童，这些儿童于 2005 年至 2019 年入组，使用回顾性（2005-2015 年）和前瞻性（2015-2019 年）收集的常规护理数据。
65 名患者在首次诊断后 24 个月有完整的随访数据，根据其演变情况（唯一的发作、反复发作或持续的疾病活动）分为单相组（n=23）、多相组（n=6）或持续组（n=36）。持续组的患者更有可能在 6 岁之前（OR 2.57，95%CI 0.70-9.46）、诊断后 12 个月时（OR 4.45，95%CI 0.58-34.20）存在关节炎持续存在和（OR 5.28，95%CI 1.39-20.01）更高频率地使用合成 DMARD（sDMARD）。虽然还评估了医生和患者的整体评估以及诊断后 12 个月的 C 反应蛋白水平等其他变量，但在调整混杂因素后，这些变量没有任何预测价值。
我们的研究结果表明，疾病早期发作、疾病演变的第一年中关节炎持续存在以及需要使用 sDMARD 可能预示着疾病的持续病程。
