Risk Factors of Persistently Active Disease among Filipino Children with Systemic Juvenile Idiopathic Arthritis: a 10-Year Study in a Tertiary Hospital
Ivy Joy E. Alberca, MA. Theresa M. Collante, Christine B. Bernal
Jul 2021 DOI 10.35460/2546-1621.2020-0043 Access
Abstract
Background: Systemic juvenile idiopathic arthritis (SJIA) is one of the most common subtypes of arthritis among children in southeast Asia with higher progression of disease activity. Unsuccessful control of the disease may lead to long-term disability resulting in functional limitations that would affect productivity of the individual.
Objective: The study determined the risk factors for persistently active disease among Filipino children aged 2 weeks to 18 years diagnosed with SJIA seen in the Section of Pediatric Rheumatology of the University of Santo Tomas Hospital (USTH) from June 2009 to June 2019.
Methodology: A retrospective cohort study was done involving chart review of both clinical division and private division patients. The following parameters were determined: sex, age at diagnosis, time elapsed from symptom onset to diagnosis, joint involvement, inflammatory markers and extra-articular manifestation. Statistical analysis included frequencies, percentages and logistic regression for the risk factors of interest.
Results: One hundred twenty-seven patients with SJIA who were appropriately treated for at least three years were included. Among which, 88 (69%) developed persistently active disease. Among them, 36 (41%) were diagnosed at 1-5 years old. Many were diagnosed (n=54, 61%) after five weeks. The most commonly affected joints were the wrists, knees and ankles. The most common contracture noted involved the cervical joint. Only 33 (26%) patients received biologic agents. Risk factors identified for the development of persistent disease activity were low hemoglobin levels at the time of diagnosis and after one month of treatment, elevated platelet count after a month, substantial joint count after three months and increased ESR after 6 months.
Conclusion: The change or improvement of the joint count and in hemoglobin, platelet count and ESR levels after appropriate treatment may determine the risk for persistently active disease in Filipino children with SJIA.
-
Petty RE, Laxer RM, Lindsley CB, Wedderburn LR. Textbook of Pediatric Rheumatology, 7th ed. Elsevier, PA;2016;205-216,p.274–84.
-
Abdwani R, Abdalla E, Al Abrawi S, Al-Zakwani I. Epidemiology of juvenile idiopathic arthritis in Oman. Pediatr Rheumatol [Internet]. 2015 Aug 1;13(1):1–2. Available from: http://dx.doi.org/10.1186/s12969-015-0030-z
-
Consolaro A, Giancane G, Alongi A, van Dijkhuizen EHP, Aggarwal A, Al-Mayouf SM, et al. Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study. The Lancet Child & Adolescent Health [Internet]. 2019 Apr;3(4):255–63. Available from: http://dx.doi.org/10.1016/S2352-4642(19)30027-6
-
Selvaag AM, Aulie HA, Lilleby V, Flatø B. Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis [Internet]. 2014 Oct 31;75(1):190–95. Available from: http://dx.doi.org/10.1136/annrheumdis-2014-206034
-
Limenis E, Feldman BM, Achonu C, Batthish M, Lang B, Mclimont M, et al. Proposed core set of items for measuring disease activity in systemic juvenile idiopathic arthritis. J Rheumatol [Internet]. 2017 Aug 1;45(1):115–21. Available from: http://dx.doi.org/10.3899/jrheum.161534
-
Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, et al. 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 Res [Internet]. 2011 Mar 30;63(4):465–82. Available from: http://dx.doi.org/10.1002/acr.20460
-
Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Reed M, et al. Early predictors of longterm outcome in patients with juvenile rheumatoid arthritis: subset-specific correlations. J Rheumatol. 2003 Mar;30(3):585–93.
-
Shen C-C, Yeh K-W, Ou L-S, Yao T-C, Chen L-C, Huang J-L. Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria: A community-based cohort study in Taiwan. Journal of Microbiology, Immunology and Infection [Internet]. 2013 Aug;46(4):288–94. Available from: http://dx.doi.org/10.1016/j.jmii.2012.03.006
-
Nigrovic PA. Review: Is there a window of opportunity for treatment of systemic juvenile idiopathic arthritis? Arthritis & Rheumatology [Internet]. 2014 May 27;66(6):1405–13. Available from: http://dx.doi.org/10.1002/art.38615
-
Singh-Grewal D, Schneider R, Bayer N, Feldman BM. Predictors of disease course and remission in systemic juvenile idiopathic arthritis: Significance of early clinical and laboratory features. Arthritis Rheum [Internet]. 2006;54(5):1595–601. Available from: http://dx.doi.org/10.1002/art.21774
-
Bartoli M, Taro M, Magni-Manzoni S, Pistorio A, Traverso F, Viola S, et al. The magnitude of early response to methotrexate therapy predicts long-term outcome of patients with juvenile idiopathic arthritis. Annals of the Rheumatic Diseases [Internet]. 2007 Oct 29;67(3):370–4. Available from: http://dx.doi.org/10.1136/ard.2007.073445
-
Spiegel LR, Schneider R, Lang BA, Birdi N, Silverman ED, Laxer RM, et al. Early predictors of poor functional outcome in systemic-onset juvenile rheumatoid arthritis: A multicenter cohort study. Arthritis & Rheumatism [Internet]. 2000;43(11):2402–9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131%28200011%2943%3A11%3C2402%3A%3AAID-ANR5%3E3.0.CO%3B2-C
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