A study on disease activity and outcome in patients with juvenile idiopathic arthritis, aged 2 months to 16 years at a tertiary care institute in North India and compare JADA’S based on ESR to JADA’S based on CRP in newly diagnosed patients
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20251700Keywords:
Disease activity, Juvenile idiopathic arthritis, Juvenile arthritis disease activity scoreAbstract
Background: Juvenile idiopathic arthritis is the most common chronic rheumatic disease of childhood. The clinical spectrum spans from time-limited mono-arthritis to ongoing aggressive poly-articular disease, and may include severe systemic features or sight-threatening uveitis.
Methods: This was a prospective 2 years study conducted from September 2018 to August 2020 in the Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, a tertiary care institute in North India. Patients were assessed individually by interview and clinical examination supported by Laboratory investigations. Patients were diagnosed and assigned to different JIA categories based on ILAR classification. Disease Activity and Outcome was measured based on JADAS-27.
Results: A total of 51 patients were enrolled in our study, based on inclusion and exclusion criteria. The most common clinical features in studied subjects were: joint pain and swelling each found in 48 (94.1%) patients, restricted joint movement found in 42 (82.3%) patients, limp found in 36 (70.5%) patients, fever in 9 (17.6%) patients, rash in 6 (11.8%) patients and joint deformity in 3 (5.9%) patients. Of the 51 patients, 24 (47%) patients had no change in disease activity, 24 (47%) improved with significant reduction in disease activity and 3 (6%) patients worsened with increased disease activity during the course of study.
Conclusions: Oligorthritis was the most common subtype of JIA observed. Joint pain and swelling were the most common presentations. Knee, ankle and hip joints were the most commonly involved joints. Disease activity was mostly moderate to high initially. Maximum improvement in disease activity on follow up was observed in oligorthritis persistent variant.
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References
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390-2.
Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):76778.
Nordal E, Zak M, Aalto K, Berntson L, Fasth A, Herlin T, et al. Nordic Study Group of Pediatric Rheumatology. Ongoing disease activity and changing categories in a long-term nordic cohort study of juvenile idiopathic arthritis. Arthritis Rheum. 2011;63(9):2809-18. DOI: https://doi.org/10.1002/art.30426
Nordal EB, Zak M, Aalto K, Berntson L, Fasth A, Herlin T, Lahdenne P, et al. Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting. Ann Rheum Dis. 2012;71(7):1122-7. DOI: https://doi.org/10.1136/annrheumdis-2011-200237
Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet. 2011;377(9783):2138-49. DOI: https://doi.org/10.1016/S0140-6736(11)60244-4
Woo P, Wedderburn LR. Juvenile chronic arthritis. Lancet. 1998;351(9107):969-73. DOI: https://doi.org/10.1016/S0140-6736(05)60640-X
Prakken BJ, Albani S. Using biology of disease to understand and guide therapy of JIA. Best Pract Res Clin Rheumatol. 2009;23(5):599-608. DOI: https://doi.org/10.1016/j.berh.2009.07.003
Martini A, Lovell DJ. Juvenile idiopathic arthritis: state of the art and future perspectives. Ann Rheum Dis. 2010;69(7):1260-3. DOI: https://doi.org/10.1136/ard.2010.133033
Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):76778
Foster HE, Cabral DA. Is musculoskeletal history and examination so different in paediatrics? Best Pract Res Clin Rheumatol. 2006;20(2):241-62. DOI: https://doi.org/10.1016/j.berh.2005.11.001
Gilliam BE, Chauhan AK, Low JM, Moore TL. Measurement of biomarkers in juvenile idiopathic arthritis patients and their significant association with disease severity: a comparative study. Clin Exp Rheumatol. 2008;26(3):492-7.
Gare BA. Epidemiology. Baillieres Clin Rheumatol. 1998;12(2):191-208. DOI: https://doi.org/10.1016/S0950-3579(98)80014-9
Wallace CA, Giannini EH, Huang B, Itert L, Ruperto N. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res(Hoboken). 2011;63(7):929-36. DOI: https://doi.org/10.1002/acr.20497
Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum. 2005;52(11):3554-62. DOI: https://doi.org/10.1002/art.21389
Van Mater HA, Williams JW, Coeytaux RR, Sanders GD, Kemper AR. Psychometric characteristics of outcome measures in juvenile idiopathic arthritis: A systematic review. Arthritis Care Res(Hoboken). 2011. DOI: https://doi.org/10.1002/acr.20667
Consolaro A, Ruperto N, Bazso A, Pistorio A, Magni-Manzoni S, Filocamo G, et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum. 2009;61(5):658-66. DOI: https://doi.org/10.1002/art.24516
Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):76778. DOI: https://doi.org/10.1016/S0140-6736(07)60363-8
Shahzad F, Nawaz Z, Aziz S. Juvenile Arthritis Disease Activity Score In Children With Juvenile Idiopathic Arthritis And Its Association With Clinical Disease Activity In Lahore, Pak Armed Forces Med J. 2018;68(5):1249-55.
Kunjir V, Venugopalan A, Chopra A. Profile of Indian patients with juvenile onset chronic inflammatory joint disease using the ILAR classification criteria for JIA: A community‑based cohort study. J Rheumatol. 2010;37:1756‑62. DOI: https://doi.org/10.3899/jrheum.090937
Suni KA, Ali A, Lal AA, Kailas L. Clinico‑immunological Profile of Juvenile Idiopathic Arthritis in Children Attending SAT Hospital, Thiruvananthapuram. Acad Med J India. 2015;28:99‑105.
Bhanji R, Camerino G, Parma P, Radi O. Genetic basis of juvenile idiopathic arthritis. Int J Rheum Dis. 2011;15:2011-3.
Hegde, Acharya A, Singh S, Kovilapu K, Udaybhanu. Clinical profile of juvenile idiopathic arthritis from a tertiary care hospital in Northern India. Indian Journal of Rheumatology. 2020. DOI: https://doi.org/10.4103/injr.injr_137_20
Aggarwal A, Agarwal V, Danda D, Misra R. Outcome in Juvenile Rheumatoid Arthritis in India. Indian Pediatrics. 2004;41(2):180-4.