Assesment of Damage in Juvenile Idiopathic Arthritis: Single Center Experience

Introduction:It is essential to evaluate the activation and the articular and extra-articular damage during the Juvenile Idiopathic Arthritis(JIA) disease course. Objectives:This study aimed to evaluate the damage status and affecting factors in JIA patients. Methods:Juvenile Arthritis Damage Index articular(JADI-A) and extra-articular(E) were evaluated in 204 JIA patients who had been followed up for two years andmore. JADI-A and E affecting factors were assessed by univariate and multivariate logistic regression analysis. Results: In this study,127(62.6%) of the patients were female. The median age was 13(IQR: 11-16), and the age at diagnosis was 7(IQR: 4-10) years. The median follow-up time was 5(IQR: 4-8) years. Ninety-two(45.3%) patients had comorbid diseases. JADI-A were median:0(min-max: 0-24), JADI-E were median:0(min-max:0-4).The annual attacks number [OR:1,759 (CI:1,300-2,379],p:<0,001),annual eritrocyte sedimantation rate (ESR) [OR:1,072(CI:1,021-1,125),p:0.005] were effective on JADI-A scores. The CRP at the first admission [OR:1.007(CI: 1,000-1,014), p:0.037], the annual ESR[OR:1,051(CI:1,008-1,095),p:0.019] were found to be effective on the JADI-E. The ideal cut-off point of the  attacks number and ESR affecting JADI-A scores were 1.38[AUC:0.734(0.641-0.828),p:0.001] and 14.32[AUC:0.617(0.514-0.721),p:0.027], respectively. The ideal cut-off point of the CRP and ESR affecting JADI-E scores were 13,25[AUC:0,662(0,541-0,782),p:0,009],and15,10[AUC:0.674(0.567-0.780),p:0.002], respectively. Steroid related complications such as, obesity in 12 (5.9%), hirsutism in 3 (1.5%), transient adrenal suppression in 14 (6.9%), 8 (3.9%), and osteoporosis were detectedin 7 (3.4%) patients. Conclusion: We have shown that parameters used routinely can be helpful to predict damage. We also think that new criteria should be added to the scoring

Factors and glucocorticoid usage affecting the prognosis of systemic juvenile idiopathic arthritis

Background The rate of glucocorticoid (GC) use is significantly higher in systemic juvenile idiopathic arthritis (SJIA) than other juvenile idiopathic arthritis subtypes. There is no consensus on the duration and dosage of GC treatment. We aimed to investigate the risk factors for a polyphasic / persistent disease course and the effect of dose and duration of GC treatment on SJIA prognosis. Methods Forty-two patients who were diagnosed with SJIA, and for whom the duration of disease was longer than 2 years, were included. Patients were divided into monophasic and others (polyphasic / persistent disease course). Risk factors for polyphasic / persistent disease course, which were clinical and laboratory findings regarding the patients, treatment options, dose, and duration of GCs, were evaluated for the first active disease periods and for all flares in the entire disease course. Results Of the 42 SJIA patients, 21 had monophasic, and 21 had polyphasic / persistent disease. Cumulative dosages and durations of glucocorticoid treatment were similar in the two groups at the first flare (odds ratio (OR): 1.032 P: 0.671; OR:1,113 P: 0.115). Durations of the first active disease period were longer in the polyphasic / persistent group (OR:1.275, P: 0.01). Active disease duration cut-off values of 1.5 months with sensitivity 85.7%, specificity 52.4% were observed on receiver operating characteristic curve analysis. The presence of hepatosplenomegaly at first flare was detected as an independent risk factor of polyphasic/persistent disease by multivariate analysis included both dosage and duration of a steroid (hazard ratio (HR): 4.129, P: 0.034), (HR: 3.992, P: 0.038). Multivariate recurrent events survival analysis determined ALT levels as a risk factor affecting polyphasic / persistent disease (HR: 0.986, P: 0.037). Conclusions Glucocorticoid dose and duration did not affect the active disease periods and disease course in SJIA. An active disease period longer than 1.5 months, presentation of hepatosplenomegaly at the initial disease course, and high ALT levels at the recurrences should warn physicians of polyphasic / persistent disease