Risk Factors of Persistently Active Disease among Filipino Children with Systemic Juvenile Idiopathic Arthritis: a 10-Year Study in a Tertiary Hospital

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.