Adult outcome of juvenile idiopathic arthritis: A nationwide population‐based retrospective cohort study in Taiwan

Abstract

Objective To clarify the development of juvenile idiopathic arthritis (JIA) to adult‐onset autoimmune diseases in a population‐based study in Taiwan. Methods We analyzed data of 107 433 children born between 1990 and 1997 from the National Taiwan Health Insurance Database. There were 262 JIA patients and 107 171 individuals without JIA who were selected and followed up until December 2013 to investigate their outcomes of adult‐onset autoimmune diseases after reaching 16 years of age. The adjusted hazard ratios (aHRs) including 95% confidence intervals (95% CI) of adult‐onset autoimmune diseases were calculated using the Cox proportional regression model among different age groups. Results The incidence rate for patients with a history of JIA was 83.56 per 105 person‐months for rheumatoid arthritis (RA), 16.61 for systemic lupus erythematosus (SLE), 58.39 for ankylosing spondylitis (AS), and 33.26 for psoriatic diseases. The aHRs were 29.60 for any autoimmune disease, 129.52 for RA, 10.01 for SLE, 49.62 for AS, and 8.20 for psoriatic diseases. Compared with non‐JIA individuals, the aHRs of adult‐onset autoimmune diseases were 34.87 (95% CI: 4.85‐250.62) at the onset age of 3‐5 years, 12.01 (95% CI: 2.99‐48.26) at the age of 6‐10 years, and 45.80 (95% CI: 29.69‐70.64) at the age of 11‐15 years. Conclusion Children with JIA were at an increased risk of developing RA, AS, psoriatic disease, and SLE in adulthood.

Prevalence of co-existing autoimmune disease in juvenile idiopathic arthritis: a cross-sectional study

“…Hence, these specific testing methods increase the likelihood of diagnosis of a co-existing autoimmune disease compared with reported ICD codes. However, consistently with the ≥ 18-year-old cohort data reported in our study, a database study in Taiwan (patients with JIA, n = 262; participants without JIA, n = 107,171), quantifying the development of adult-onset rheumatic diseases among patients with JIA aged ≥16 years, noted increased hazard ratios for ankylosing spondylitis, psoriasis, Sjögren's syndrome, SLE, and psoriatic arthritis [44].…”

Comment on “An overview of the relationship between juvenile idiopathic arthritis and potential environmental risk factors: Do early childhood habits or habitat play a role in the affair?”

“…First, one of the findings in this study showed that low socioeconomic status negatively affected the control of JIA. We discovered that a previous study had disclosed a higher risk for JIA patients to develop rheumatoid arthritis (RA) 2 and another study showed the strong relations between low socioeconomic status and RA 3 . Those 2 studies might support the authors' study perspective of the association between socioeconomic status and the risk of developing JIA.…”

Reply to comment by Kao et al on “An overview of the relationship between juvenile idiopathic arthritis and potential environmental risk factors: Do early childhood habits or habitat play a role in the affair?”

“…An outcome study on JIA evaluating the frequency of developing adult‐onset autoimmune diseases has been pointed out. Overall, the fact that autoimmune diseases have a similar genetic background with multiple susceptibility genes, hereditary causes have been focused on nevertheless, when assessed by the age spectrum, it was concluded that younger patients were more likely to develop rheumatic diseases afterwards if they were exposed to environmental risk factors 3 . Besides the agents that trigger the emergence of the disease, factors affecting the outcome, such as socioeconomic level, have been also reviewed in our study.…”