Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 20, Ljubljana, 1000, Slovenia.
Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Arthritis Res Ther. 2024 Mar 14;26(1):69. doi: 10.1186/s13075-024-03303-y.
To evaluate long-term outcomes and prognostic factors in patients with juvenile idiopathic arthritis (JIA), presenting as oligoarthritis, who received IAC as the first treatment for their disease.
We conducted retrospective study at the University Children's Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups.
We included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77).
Almost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy.
评估幼年特发性关节炎（JIA）患儿出现寡关节炎，接受 IAC 作为疾病初始治疗后的长期结局和预后因素。
我们在斯洛文尼亚卢布尔雅那大学儿童医院进行了一项回顾性研究，纳入 2015 年 1 月至 2023 年 5 月接受 IAC 作为初始治疗的 JIA 患儿，患儿临床表现为寡关节炎。收集患者和治疗数据，根据后续治疗需求将结局分为三组：无需治疗、仅需额外 IAC 和需要全身治疗。后一组根据是否需要 bDMARD 进一步细分。对数秩（Mantel-Cox）生存分析比较了不同结局组。
共纳入 109 例 JIA 患儿，表现为寡关节炎（63%为女性），首先接受 IAC 治疗。IAC 时的平均年龄为 8.0 岁，随访时间为 4.3 年。值得注意的是，38.5%的患儿 IAC 后无需额外治疗，15.5%仅需额外 IAC。45.9%的患儿需要全身治疗，主要为甲氨蝶呤（MTX），IAC 后平均 7.8 个月开始。平均 2.2 年后开始生物治疗，占 22%。注射关节数与生物制剂的需求相关。末次随访时，88.9%的患儿疾病处于缓解状态。ANA 阳性（P=0.049，卡方 3.89）和 HLA B27 抗原阳性（P=0.050，卡方 3.85）与需要全身治疗相关。ANA 和 HLA B27 阴性、年龄大于 8 岁的患儿亚组与其他患儿相比，全身治疗（25.8%）和生物治疗（9.6%）需求显著减少（p=0.050，卡方 3.77）。
约 40%接受 IAC 治疗的寡关节炎 JIA 患儿未进展为慢性疾病。年龄较小、ANA 阳性和 HLA B27 阳性是全身治疗的预测因素，而注射关节数预测未来对生物治疗的需求。
