Juvenile idiopathic arthritis in adulthood: fulfilment of classification criteria for adult rheumatic diseases, long-term outcomes and predictors of inactive disease, functional status and damage

Abstract

ObjectivesTo determine how adult juvenile idiopathic arthritis (JIA) patients fulfil classification criteria for adult rheumatic diseases, evaluate their outcomes and determine clinical predictors of inactive disease, functional status and damage.MethodsPatients with JIA registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) older than 18 years and with more than 5 years of disease duration were included. Data regarding sociodemographic features, fulfilment of adult classification criteria, Health Assessment Questionnaire, Juvenile Arthritis Damage Index—articular (JADI-A) and Juvenile Arthritis Damage Index—extra-articular (JADI-E) damage index and disease activity were analysed.Results426 patients were included. Most of patients with systemic JIA fulfilled criteria for Adult Still's disease. 95.6% of the patients with rheumatoid factor (RF)-positive polyarthritis and 57.1% of the patients with RF-negative polyarthritis matched criteria for rheumatoid arthritis (RA). 38.9% of the patients with extended oligoarthritis were classified as RA while 34.8% of the patients with persistent oligoarthritis were classified as spondyloarthritis. Patients with enthesitis-related arthritis fulfilled criteria for spondyloarthritis in 94.7%. Patients with psoriatic arthritis maintained this classification. Patients with inactive disease had lower disease duration, lower diagnosis delay and corticosteroids exposure. Longer disease duration was associated with higher HAQ, JADI-A and JADI-E. Higher JADI-A was also associated with biological treatment and retirement due to JIA disability and higher JADI-E with corticosteroids exposure. Younger age at disease onset was predictive of higher HAQ, JADI-A and JADI-E and decreased the chance of inactive disease.ConclusionsMost of the included patients fulfilled classification criteria for adult rheumatic diseases, maintain active disease and have functional impairment. Younger age at disease onset was predictive of higher disability and decreased the chance of inactive disease.

Long-Term Effects of Articular and Extra-Articular Damage in Adult Patients with Juvenile Idiopathic Arthritis and Different Immunogenic Markers

“…This exceeded the data presented by Selvaag AM, et al [9], who informed that 41% of patients with JIA had active disease after 30 years of observation, as well as the data of another investigation, which registered 37-43% of patients with active disease [13]. Oliver's-Ramas et al [5] registered 67% of patients with active disease in adulthood. The researchers attribute the higher percentage to the fact that to assess disease activeness, they applied scales introduced for rheumatic diseases in adulthood.…”

Treatment to Target Using Recombinant Interleukin‐1 Receptor Antagonist as First‐Line Monotherapy in New‐Onset Systemic Juvenile Idiopathic Arthritis: Results From a Five‐Year Follow‐Up Study

“…The natural course of systemic JIA is severe. Data from cohorts in the pre‐biologics era showed that half of the patients had persistent active disease for years and articular damage was common; some investigators even reported joint replacements in 75% of systemic JIA patients . Disease‐modifying antirheumatic drugs (DMARDs) that were beneficial in other subtypes of JIA were ineffective in systemic JIA, and patients with refractory disease relied on long‐term glucocorticoid use, or autologous stem cell transplantation as a last resort .…”

Predicting disease outcomes in juvenile idiopathic arthritis: challenges, evidence, and new directions

“…Arthritis and other extra-articular manifestations of JIA result in pain, loss of functional ability and joint destruction 5 . Therefore, most current pharmaceutical therapies for JIA are targeted at the underlying inflammation of disease with the aim of treating both inflammation and the symptoms of disease, such as pain.…”