Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden.
Skåne University Hospital, Lund and Malmö, Sweden.
Pediatr Rheumatol Online J. 2024 Oct 19;22(1):92. doi: 10.1186/s12969-024-01030-x.
There is no consensus or clinical guidelines for screening routines of autoimmune disease in individuals with juvenile idiopathic arthritis (JIA), since results are conflicting whether the risk for such conditions is increased or not among individuals with JIA. The aim of this study was to investigate if the frequency of comorbid autoimmune conditions is increased after JIA diagnosis in a validated population-based JIA cohort in southern Sweden.
Autoimmune comorbidities were evaluated in a pre-existing population-based JIA cohort of 302 participants, constituting of individuals diagnosed with a validated JIA diagnosis 2000-2010 in southern Sweden. The comorbidities were determined through analysis of diagnosis codes registered after the JIA diagnosis and until 2019. With the use of a reference population of 1510 age- and sex matched individuals, hazard ratios (HR) were calculated with Cox proportional models.
During the study period, 7.7% of the JIA cohort received an autoimmune diagnosis after their JIA diagnosis. Individuals with JIA had an increased risk of autoimmune diseases in general (HR 4.11, 95% CI 2.13-7.91) within the first 7 years of disease, as well as separately for coeliac disease (HR 5.24, 95% CI 1.76-15.65) and hypothyroidism (HR 3.74, 95% CI 1.14-12.30) compared to the reference population. Antinuclear antibody (ANA) positivity was associated with a significantly increased risk of comorbid autoimmune disease in the JIA cohort, with HR 6.21 (95% CI 1.64-23.55) for ANA positive individuals.
Individuals with JIA have a significantly increased risk of being diagnosed with an autoimmune condition after receiving their JIA diagnosis compared to matched references. ANA positivity is associated with a further increased risk. Our results emphasize awareness in physicians of additional autoimmune disorders in individuals with JIA and advocate serological screening of autoimmune conditions during follow-up.
由于幼年特发性关节炎（JIA）患者中是否存在此类疾病风险增加的结果存在争议，因此对于此类患者的自身免疫疾病筛查常规尚无共识或临床指南。本研究旨在调查在瑞典南部一个经过验证的基于人群的 JIA 队列中，在 JIA 诊断后自身免疫合并症的频率是否增加。
在瑞典南部一个包含 302 名参与者的已建立的基于人群的 JIA 队列中评估了自身免疫合并症。这些参与者在 2000-2010 年间被确诊为 JIA。通过分析 JIA 诊断后直至 2019 年登记的诊断代码来确定合并症。使用 1510 名年龄和性别匹配的参考人群，使用 Cox 比例模型计算了风险比（HR）。
在研究期间，JIA 队列中有 7.7%的患者在 JIA 诊断后被诊断出患有自身免疫性疾病。在疾病的前 7 年内，JIA 患者自身免疫性疾病的总体风险增加（HR 4.11，95%CI 2.13-7.91），分别为乳糜泻（HR 5.24，95%CI 1.76-15.65）和甲状腺功能减退症（HR 3.74，95%CI 1.14-12.30）。与参考人群相比，抗核抗体（ANA）阳性与 JIA 队列中自身免疫合并症的风险显著增加相关，ANA 阳性患者的 HR 为 6.21（95%CI 1.64-23.55）。
与匹配的参考人群相比，JIA 患者在接受 JIA 诊断后被诊断出患有自身免疫性疾病的风险显著增加。ANA 阳性与进一步增加的风险相关。我们的结果强调了医生在 JIA 患者中应注意其他自身免疫性疾病，并提倡在随访期间进行自身免疫性疾病的血清学筛查。
