Ongoing Disease Activity and Changing Categories in a Long-Term Nordic Cohort Study of Juvenile Idiopathic Arthritis
Ongoing Disease Activity and Changing Categories in a Long-Term Nordic Cohort Study of Juvenile Idiopathic Arthritis
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DOI：
10.1002/art.30426
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发表时间：
2011-09-01
影响因子：
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通讯作者：
Rygg, Marite
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文献类型：
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作者：
Nordal, Ellen;Zak, Marek;Rygg, Marite
Objective.描述以人群为基础的幼年特发性关节炎（JIA）患者的疾病特征、长期病程和预后。在一项前瞻性、多中心队列研究中，纳入了来自丹麦、芬兰、瑞典和挪威特定地理区域的JIA病例，这些病例在1997-2000年发病。该研究的设计尽可能接近基于人群的研究，只有在能够将所有被诊断出JIA的儿童纳入其集水区的情况下，中心才会参与。结果。在纳入的500名儿童中，440名（88.0%）进行了重复访视，末次访视发生在疾病发作后至少7年（中位数98个月，范围84-147个月）。在10.8%的儿童中观察到国际流变学协会联盟类别的变化，此外，在少关节JIA组中，34.7%的儿童出现了广泛的少关节炎。在观察期内，58.0%的儿童接受了疾病缓解抗风湿药物治疗，包括生物药物。正在进行的疾病活动大多是轻微的，但一些JIA相关的损害在22.9%的儿童中发展。在末次随访时，42.4%的儿童在药物治疗后缓解，8.9%的儿童在药物治疗后缓解，48.7%的儿童未缓解。持续性少关节型JIA和系统性JIA的缓解率最高。在这项以北欧人群为基础的JIA长期前瞻性研究中，大多数儿童的疾病进展明显。目前的研究结果强调，需要确定早期预测结果，以进一步改善治疗，并继续长期随访的JIA患者。
Objective. To describe the disease characteristics, long-term course, and outcome of patients with juvenile idiopathic arthritis (JIA) in a population-based setting.Methods. Consecutive cases of JIA from defined geographic areas of Denmark, Finland, Sweden, and Norway in whom disease onset occurred in 1997-2000 were included in a prospective, multicenter cohort study. The study was designed to be as close to a population-based study as possible, with centers participating only if they were able to include in their catchment area all children in whom JIA was diagnosed.Results. Of 500 children included, 440 (88.0%) had repeated visits, with the last visit occurring at least 7 years after disease onset (median 98 months, range 84-147 months). Changes in the International League of Associations for Rheumatology category were observed in 10.8% of the children, and, in addition, extended oligoarthritis developed in 34.7% of the group with oligoarticular JIA. During the observation period, 58.0% of the children were treated with diseasemodifying antirheumatic drugs, including biologic medications. Ongoing disease activity was mostly mild, but some JIA-related damage developed in 22.9% of the children. At the last followup visit, remission off medication was observed in 42.4% of the children, 8.9% were in remission on medication, and 48.7% were not in remission. The highest rates of remission were observed in patients with persistent oligoarticular JIA and in those with systemic JIA.Conclusion. In this long-term prospective study of JIA in a population-based Nordic setting, ongoing disease was evident in a majority of the children. The present results underline the need to identify early predictors of outcome, to further improve therapy, and to continue long-term followup of patients with JIA.