The early pattern of joint involvement predicts disease progression in children with oligoarticular (pauciarticular) juvenile rheumatoid arthritis
The early pattern of joint involvement predicts disease progression in children with oligoarticular (pauciarticular) juvenile rheumatoid arthritis
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DOI：
10.1002/art.10544
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发表时间：
2002-10-01
影响因子：
--
通讯作者：
Cabral, DA
中科院分区：
文献类型：
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作者：
Al-Matar, MJ;Petty, RE;Cabral, DA
客观的。评估疾病前 6 个月的特征，这些特征可能与少关节型幼年类风湿性关节炎 (oligo-JRA) 患者的不良结局相关，主要通过延长至多关节病程来衡量。方法。这项研究是对符合美国风湿病学会寡聚 JRA 标准、随访至少 5 年且没有幼年型银屑病关节炎、脊柱关节病样疾病或类风湿因子阳性的患者的回顾性研究。收集了疾病前 6 个月的数据。对连续变量进行二分，然后通过单变量分析筛选与最后一次随访时不良结果的关联，通过累及范围的扩展（> 4 个累积的累及关节）和“临床有意义”的扩展（大于或等于 10 个累积的关节）来衡量。与后一种结果显着相关的变量，加上疾病持续时间作为混杂的自变量，被纳入多元逻辑回归分析中。然后在单独的多重逻辑回归模型中检查相同的变量，以观察其他结果指标，包括随时使用缓解病情抗风湿药物 (DMARD)、射线照片上的糜烂性疾病、曾经发生的任何疾病缓解、医生最后一次就诊时对疾病活动的总体评估以及通过儿童健康评估问卷 (C-HAQ)/HAQ 测量的残疾。结果。在 205 名患者（其中 160 名女性）中，研究时间中位数为 10.8 年（范围为 5-26.6 年）时，39.5% 的患者出现了超过 4 个关节的关节炎，17.6% 的患者出现了大于或等于 10 个关节的关节炎。使用逻辑回归模型，对称性疾病可预测不良结果的所有指标：扩展到大于或等于 10 个关节（比值比 [OR] 19.2）、需要使用 DMARD（OR 11.5）、放射学显示糜烂性疾病（OR 4.73）、最后一次随访时的炎症活动（OR 3.23）、疾病无缓解（OR 4.73）以及通过 C-HAQ 评分 >0.12（或 2.95）。踝关节和/或腕部疾病可预测延伸（OR 6.61）和糜烂（OR 3.59）。仅手腕疾病就可以预测是否需要使用 DMARD（OR 5.87）以及最后一次随访时的炎症性疾病活动性（OR 4.01）。红细胞沉降率 (ESR) 升高可预测病情延长 (OR 3.76)、需要使用 DMARD (OR 6.47) 以及疾病无缓解 (OR 2.30)。疾病持续时间是扩展（OR 1.18）和糜烂性疾病（OR 1.19）的混杂变量。结论。患有寡聚 JRA 的儿童早期出现踝关节和/或腕部疾病、对称性关节受累以及 ESR 升高表明疾病进展的可能性。
Objective. To evaluate features during the first 6 months of disease that may be associated with a poor outcome as measured principally by extension to a polyarticular disease course in patients with oligoarticular-onset juvenile rheumatoid arthritis (oligo-JRA).Methods. This study was a retrospective review of patients who fulfilled the American College of Rheumatology criteria for oligo-JRA, were followed up for at least 5 years, and did not have juvenile psoriatic arthritis, spondylarthropathy-like disease, or rheumatoid factor positivity. Data from the first 6 months of disease were collected. Continuous variables were dichotomized and then screened by univariate analysis for association with poor outcome at the last followup visit, as measured by extension of involvement (>4 accumulated involved joints) and by "clinically meaningful" extension (greater than or equal to10 accumulated joints). Variables significantly associated with this latter outcome, with the addition of disease duration as a confounding independent variable, were included in a multiple logistic regression analysis. The same variables were then examined in separate multiple logistic regression models to look at other measures of outcome, including use of disease-modifying antirheumatic drugs (DMARDs) at any time, erosive disease on radiographs, any remission of disease ever occurring, physician's global assessment of disease activity at the last visit, and disability as measured by the Childhood Health Assessment Questionnaire (C-HAQ)/HAQ.Results. Of the 205 patients (160 of whom were female) studied for a median of 10.8 years (range 5-26.6 years), 39.5% developed extension to >4 joints and 17.6% developed arthritis in greater than or equal to10 joints. Using the logistic regression model, symmetric disease was predictive of all measures of poor outcome: extension to greater than or equal to10 joints (odds ratio [OR] 19.2), the need to use DMARDs (OR 11.5), radiographic demonstration of erosive disease (OR 4.73), inflammatory activity at last followup visit (OR 3.23), no remission of disease (OR 4.73), and disability as measured by a C-HAQ score >0.12 (OR 2.95). Ankle and/or wrist disease was predictive of extension (OR 6.61) and erosions (OR 3.59). Wrist disease alone was predictive of the need to use DMARDs (OR 5.87) and of inflammatory disease activity at the last followup visit (OR 4.01). An elevated erythrocyte sedimentation rate (ESR) was predictive of extension (OR 3.76), the need to use DMARDs (OR 6.47), and no remission of disease (OR 2.30). Disease duration was a confounding variable for extension (OR 1.18) and erosive disease (OR 1.19).Conclusion. The early presence of ankle and/or wrist disease, symmetric joint involvement, and an elevated ESR in a child with oligo-JRA indicates the likelihood of disease progression.