Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, J West 3Rd Floor, Columbus, OH, 43205, USA.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
Clin Rheumatol. 2024 Nov;43(11):3449-3455. doi: 10.1007/s10067-024-07130-z. Epub 2024 Sep 4.
Juvenile idiopathic arthritis (JIA) is common in pediatric rheumatology. Despite treatment, many patients experience persistent disease activity. Joint hypermobility (JH), defined by an excessive range of motion across multiple joints, is prevalent in children and adolescents and may influence disease outcomes in JIA.
This study examines the impact of JH on symptoms in youth and young adults with JIA.
Data were obtained from the PR-COIN network and included patients under 21 years old with a diagnosis of JIA. Patients with JIA and JH were matched with those having JIA-only based on age, sex assigned at birth, JIA subtype, and medication exposure. Clinical data, including disease activity measures, patient well-being, and pain ratings, were collected at baseline and follow-up visits.
The sample included 420 patients with JIA + JH and 2100 with JIA only. The JIA + JH group exhibited higher disease activity at baseline, more active arthritis joints, elevated physician global assessment of disease activity scores, and worse patient-reported well-being. These differences persisted over time. The JIA + JH group had a 19-20% greater likelihood of maintaining high disease activity scores and worsening over subsequent visits, indicating a significant impact of JH on disease progression.
JH in youth with JIA is associated with higher and persistent disease activity, suggesting that JH significantly contributes to the disease burden in patients with JIA and should be considered in treatment strategies. Future research should further explore the mechanisms by which JH influences disease activity and investigate comprehensive management approaches to improve outcomes for this population. Key Points • Children with JIA and joint hypermobility (JH) exhibit significantly higher disease activity at baseline compared to those with JIA only, including more active arthritis joints and elevated physician global assessment scores. • The presence of JH in JIA patients is associated with poorer patient-reported well-being and higher overall disease activity scores, which persist over time despite treatment. • JIA + JH patients have a 19-20% greater likelihood of maintaining high disease activity and worsening over subsequent visits, indicating a significant impact of JH on disease progression. • The study suggests that JH should be considered an important clinical factor in the management of JIA, with targeted interventions needed to address the increased disease activity and improve overall patient outcomes.
幼年特发性关节炎（JIA）在儿科风湿病中较为常见。尽管进行了治疗，但许多患者仍存在持续性疾病活动。关节过度活动（JH）是指多个关节的活动范围过大，在儿童和青少年中较为普遍，可能会影响 JIA 的疾病结局。
本研究旨在探讨 JH 对 JIA 青少年和年轻患者症状的影响。
数据来自 PR-COIN 网络，包括年龄在 21 岁以下、诊断为 JIA 的患者。将 JIA 合并 JH 的患者与仅患有 JIA 的患者按照年龄、出生时的性别分配、JIA 亚型和药物暴露情况进行匹配。在基线和随访时收集临床数据，包括疾病活动度指标、患者的整体健康状况和疼痛评分。
样本包括 420 例 JIA+JH 患者和 2100 例仅患有 JIA 的患者。JH 组在基线时的疾病活动度更高，活跃关节炎关节更多，医生整体评估疾病活动度评分更高，患者自述的整体健康状况更差。这些差异随时间持续存在。JH 组在后续就诊中保持高疾病活动度评分和病情恶化的可能性增加 19-20%，这表明 JH 对疾病进展有显著影响。
JIA 青少年中的 JH 与更高且持续的疾病活动度相关，表明 JH 显著增加了 JIA 患者的疾病负担，应在治疗策略中加以考虑。未来的研究应进一步探讨 JH 影响疾病活动度的机制，并研究全面的管理方法，以改善这一人群的预后。
与仅患有 JIA 的患者相比，患有 JIA 和关节过度活动（JH）的儿童基线时的疾病活动度明显更高，包括更多活跃的关节炎关节和更高的医生整体评估评分。
JIA 患者存在 JH 与较差的患者自述健康状况和更高的总体疾病活动度评分相关，这些评分在治疗后仍持续存在。
JIA+JH 患者保持高疾病活动度和病情恶化的可能性增加 19-20%，这表明 JH 对疾病进展有显著影响。
研究表明，JH 应被视为 JIA 管理中的一个重要临床因素，需要采取针对性干预措施来解决疾病活动度增加的问题，改善患者的整体预后。
