Long-term outcome and prognostic factors in enthesitis-related arthritis - A case-control
Long-term outcome and prognostic factors in enthesitis-related arthritis - A case-control
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DOI：
10.1002/art.22181
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发表时间：
2006-11-01
影响因子：
--
通讯作者：
Vinje, Odd
中科院分区：
文献类型：
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作者：
Flato, Berit;Hoffmann-Vold, Anna-Maria;Vinje, Odd
Objective.比较附着点炎相关性关节炎（ERA）患者与其他亚型幼年特发性关节炎（JIA）患者和健康对照者的临床、功能和影像学结局，并确定预测ERA缓解、骶髂关节炎和身体限制发展的遗传标记、患者特征和早期疾病变量。研究了1980年至1985年期间首次入住Rikshospitalet医疗中心的55名ERA儿童。在同一时期入院的少关节炎或多关节炎患者（n = 55）和来自国家人口登记处的个体（n = 55）在性别和年龄上相匹配，并用作对照。在中位患病15.3年（范围11.7-21.9年）后评估健康状况，对于某些患者，在中位患病23.0年（范围19.7-29.4年）后使用36项简式健康调查和健康评估问卷重新评估健康状况。在15年随访访视时进行临床和影像学检查。通过图表回顾性获得与疾病发作相关的变量。通过基因分型和血清学检测确定HLA等位基因。与少关节炎或多关节炎患者（中位数为15.3年和23.0年）和正常对照组（中位数为15.3年）相比，ERA患者的身体功能水平较低，身体健康状况较差，身体疼痛更多。在ERA患者中，44%出现缓解，35%观察到骶髂关节炎，75%观察到脊柱屈曲度降低。未能达到疾病缓解的预测因素包括：一级亲属中的强直性脊柱炎（AS）、HLA-DRB 1 *08的存在和前6个月内的踝关节炎。HLA-DPB 1 *02是骶髂关节炎的保护因素，而持续升高的红细胞沉降率（ESR）和前6个月内的髋关节炎是骶髂关节炎的危险因素。女性、AS家族史以及前6个月内受影响关节的数量高，预示着23年后身体健康状况不佳。男性与脊柱前屈减少有关。在这项研究中，与少关节或多关节JIA患者和普通人群对照组相比，ERA患者的身体结局较差。相关疾病家族史、性别、HLA-DRB 1 *08的存在、HLA-DPBI*02的缺乏、持续升高的ESR、早期髋关节或踝关节炎以及大量受累关节是不利结局的预测因素。
Objective. To compare the clinical, functional, and radiographic outcomes in patients with enthesitis-related arthritis (ERA) with those in patients with other subtypes of juvenile idiopathic arthritis (JIA) and healthy controls, and to determine genetic markers, patient characteristics, and early disease variables that predict the development of remission, sacroiliitis, and physical limitations in ERA.Methods. Fifty-five children with ERA who were first admitted to Rikshospitalet Medical Center between 1980 and 1985 were studied. Patients with oligoarthritis or polyarthritis who were admitted during the same period (n = 55) and individuals from a national population registry (n = 55) were matched for sex and age and used as controls. Health status was assessed after a median of 15.3 years of disease (range 11.7-21.9 years) and, in some patients, was reassessed after a median of 23.0 years (range 19.7-29.4 years) of disease, by use of the 36-item Short Form health survey and the Health Assessment Questionnaire. Clinical and radiographic examinations were performed at the 15-year followup visit. Variables relating to the onset of disease were retrospectively obtained by chart review. HLA alleles were determined by genotyping and serologic testing.Results. Patients with ERA had lower levels of physical functioning, poorer physical health, and more bodily pain compared with patients with oligoarthritis or polyarthritis (after a median of 15.3 and a median of 23.0 years) and normal controls (after a median of 15.3 years). Among patients with ERA, remission occurred in 44%, sacroiliitis was observed in 35%, and reduced spinal flexion was observed in 75%. Predictors of failure to attain disease remission included the following: ankylosing spondylitis (AS) in a first-degree relative, the presence of HLA-DRB1*08, and ankle arthritis within the first 6 months. HLA-DPB1*02 was a protective factor, whereas a persistently elevated erythrocyte sedimentation rate (ESR), and hip arthritis within the first 6 months were risk factors for sacroiliitis. Female sex, a family history of AS, and high numbers of affected joints within the first 6 months predicted poor physical health status after 23 years. Male sex was associated with reduced anterior flexion of the spine.Conclusion. In this study, patients with ERA had poorer physical outcomes compared with patients with oligoarticular or polyarticular JIA and controls from the general population. A family history of related diseases, sex, the presence of HLA-DRB1*08, the absence of HLA-DPBI*02, a persistently elevated ESR, early hip or ankle arthritis, and high numbers of affected joints were predictors of an unfavorable outcome.