Published November 30, 2018 | Version v1
Journal article Open

Influence of therapy on the development of long-term articular and extra-articular damages in adult patients with juvenile idiopathic arthritis

Creators

  • 1. Bohomolets National Medical University

Description

Aim of the research: to evaluate the effect of therapy on the development of articular and extra-articular damages in adult patients with JIA.

Materials and methods: the study included 163 patients aged >18 years, with a JIA according to the ILAR classification. The study did not include patients with disease duration <3 years. The JADAS-10 disease activity, functional capacity (HAQ), articular (JADI-A) and extra-articular (JADI-E) damages of JIA were evaluated. The received therapy, a dose and duration of reception of various medications were analyzed.

Results. JADI-A>1 was detected in 36.9 %, and JADI-E>1 was detected in 30.7 % of patients. Remission was diagnosed in 37 (41.6 %) patients with JIA. Most patients (67 %) had previously taken glucocorticoids (GC). Only 25 % of patients received GC at the time of observation, 28 (17.2 %) received only non-steroidal anti-inflammatory drugs (NSAIDs), 134 (82.2 %) – disease-modifying anti-rheumatic drugs (DMARDs). Biological therapy (BT) was received earlier or at the time of the examination in 23.9 % of patients. JADI-A was more frequently observed in RF-negative polyarthritis (47.1 % of patients vs 15.5 %, p<0.05). Presence of articular damages (JADI-A>1) in patients with persistent oligoarthritis was observed in 16.7 % of patients vs in 31.1 % without long-term joint damages (p<0.05). Extra-articular damages (JADI-E>1) were observed more often in RF-negative polyarthritis (in 36 % of patients vs 20.4 %, p<0.05). In patients without articular (JADI-A<1, 33.0 % vs. 5 %, p<0.05) and extra-articular damages (JADI-E<1, 30.1 % vs 6 %, p<0.05) remission was diagnosed more often. Patients with JADI-A>1 and JADI-E>1 had higher degree of JADAS activity (p<0.05) and a worse functional capacity for HAQ (p<0.05). Patients with long-term extra-articular damages in adulthood were more likely to take GC in history or continued to take GC than patients without extra-articular damages (p<0.01), they received longer GC (p<0.01) and the cumulative dose of GC was higher (p<0.01). However, both groups did not differ in the prescribing BT. Although a difference was found both in the administration of DMARDs, in the duration of treatment with DMARDs and the number of DMARDs assigned sequentially or in parallel in patients with long-term extra-articular damages (p<0.05). Patients with extra-articular damages needed intensification of therapy with BT more often (p <0.05) than patients without JADI-E.

Conclusions: the presence of JIA in childhood leads to the development of articular damages in adulthood. These damages are observed more often in patients with RF-positive and RF-negative poly-arthritic JIA than with enthesitis-associated arthritis JIA and JIA with extended oligoarthritis. Extra-articular damages were developed in RF-positive and RF-negative poly-arthritic JIA more often than in oligoarthritic JIA and enthesitis-associated arthritis JIA. The development of long-term articular and extra-articular damages in adulthood is associated with a history of GC intake (p<0.01) and usage of GC at the time of examination (p<0.01), with a longer duration of GC intake (p<0.01) and a higher cumulative dose of GC (p<0.01). In order to reduce the development of long- term articular and extra-articular damages in adulthood DMARDs and BT should be more often administrated, as well as to avoid long- term use and high doses of GC

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References

  • Viola, S., Felici, E., Magni-Manzoni, S., Pistorio, A., Buoncompagni, A., Ruperto, N. et. al. (2005). Development and validation of a clinical index for assessment of long-term damage in juvenile idiopathic arthritis. Arthritis & Rheumatism, 52 (7), 2092–2102. doi: https://doi.org/10.1002/art.21119
  • Beukelman, T., Patkar, N. M., Saag, K. G., Tolleson-Rinehart, S., Cron, R. Q., DeWitt, E. M. et. al. (2011). 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: Initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care & Research, 63 (4), 465–482. doi: https://doi.org/10.1002/acr.20460
  • Kearsley-Fleet, L., Beresford, M. W., Davies, R., De Cock, D., Baildam, E. et. al. (2018). Short-term outcomes in patients with systemic juvenile idiopathic arthritis treated with either tocilizumab or anakinra. Rheumatology. doi: https://doi.org/10.1093/rheumatology/key262
  • Fellas, A., Coda, A., Hawke, F. (2017). Physical and Mechanical Therapies for Lower-Limb Problems in Juvenile Idiopathic Arthritis. Journal of the American Podiatric Medical Association, 107 (5), 399–412. doi: https://doi.org/10.7547/15-213
  • Weitzman, E. R., Wisk, L. E., Salimian, P. K., Magane, K. M., Dedeoglu, F., Hersh, A. O. et. al. (2018). Adding patient-reported outcomes to a multisite registry to quantify quality of life and experiences of disease and treatment for youth with juvenile idiopathic arthritis. Journal of Patient-Reported Outcomes, 2 (1). doi: https://doi.org/10.1186/s41687-017-0025-2
  • Wang, S.-J., Yang, Y.-H., Lin, Y.-T., Yang, C.-M., Chiang, B.-L. (2002). Attained Adult Height in Juvenile Rheumatoid Arthritis with or without Corticosteroid Treatment. Clinical Rheumatology, 21 (5), 363–368. doi: https://doi.org/10.1007/s100670200098
  • Alsulami, R. A., Alsulami, A. O., Muzaffer, M. A. (2017). Growth Pattern in Children with Juvenile Idiopathic Arthritis: A Retrospective Study. Open Journal of Rheumatology and Autoimmune Diseases, 07 (01), 80–95. doi: https://doi.org/10.4236/ojra.2017.71007
  • Canalis, E. (2005). Mechanisms of glucocorticoid action in bone. Current Osteoporosis Reports, 3 (3), 98–102. doi: https://doi.org/10.1007/s11914-005-0017-7
  • Stagi, S., Cavalli, L., Signorini, C., Bertini, F., Cerinic, M., Brandi, M., Falcini, F. (2014). Bone mass and quality in patients with juvenile idiopathic arthritis: longitudinal evaluation of bone-mass determinants by using dual-energy x-ray absorptiometry, peripheral quantitative computed tomography, and quantitative ultrasonography. Arthritis Research & Therapy, 16 (2), R83. doi: https://doi.org/10.1186/ar4525
  • Brabnikova Maresova, K. (2011). Secondary Osteoporosis in Patients with Juvenile Idiopathic Arthritis. Journal of Osteoporosis, 2011, 1–7. doi: https://doi.org/10.4061/2011/569417
  • Susic, G., Atanaskovic, M., Stojanovic, R., Radunovic, G. (2018). Bone mineral density in children with juvenile idiopathic arthritis after one year of treatment with etanercept. Srpski Arhiv Za Celokupno Lekarstvo, 146 (5-6), 297–302. doi: https://doi.org/10.2298/sarh170811175s
  • Frittoli, R. B., Longhi, B. S., Silva, A. M., Filho, A. de A. B., Monteiro, M. Â. R. de G., Appenzeller, S. (2017). Effects of the use of growth hormone in children and adolescents with juvenile idiopathic arthritis: a systematic review. Revista Brasileira de Reumatologia (English Edition), 57 (2), 100–106. doi: https://doi.org/10.1016/j.rbre.2016.07.009
  • Petty, R. E., Southwood, T. R., Manners, P. et. al. (2004). International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton 2001. J. Rheumatol, 31 (2), 390–392.
  • Bulatovic Calasan, M., de Vries, L. D., Vastert, S. J., Heijstek, M. W., Wulffraat, N. M. (2013). Interpretation of the Juvenile Arthritis Disease Activity Score: responsiveness, clinically important differences and levels of disease activity in prospective cohorts of patients with juvenile idiopathic arthritis. Rheumatology, 53 (2), 307–312. doi: https://doi.org/10.1093/rheumatology/ket310
  • Anderson, J., Sayles, H., Curtis, J. R., Wolfe, F., Michaud, K. (2010). Converting modified health assessment questionnaire (HAQ), multidimensional HAQ, and HAQII scores into original HAQ scores using models developed with a large cohort of rheumatoid arthritis patients. Arthritis Care & Research, 62 (10), 1481–1488. doi: https://doi.org/10.1002/acr.20265
  • Pincus, T., Castrejon, I. (2013). Evidence that the strategy is more important than the agent to treat rheumatoid arthritis. Data from clinical trials of combinations of non-biologic DMARDs, with protocol-driven intensification of therapy for tight control or treat-to-target. Bull Hosp Jt Dis., 71, S33–S40.
  • Smolen, J. S., Landewé, R., Bijlsma, J., Burmester, G., Chatzidionysiou, K., Dougados, M. et. al. (2017). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Annals of the Rheumatic Diseases, 76 (6), 960–977. doi: https://doi.org/10.1136/annrheumdis-2016-210715
  • Consolaro, A., Ruperto, N., Bazso, A., Pistorio, A., Magni-Manzoni, S., Filocamo, G. (2009). Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis & Rheumatism, 61 (5), 658–666. doi: https://doi.org/10.1002/art.24516
  • Swart, J. F., van Dijkhuizen, E. H. P., Wulffraat, N. M., de Roock, S. (2017). Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis. Annals of the Rheumatic Diseases, 77 (3), 336–342. doi: https://doi.org/10.1136/annrheumdis-2017-212104