P035 Hip involvement in Tunisian Juvenile Idiopathic Arthritis patients

Abstract Background Juvenile idiopathic arthritis (JIA) is characterized by a widely variable clinical course and outcome. If uncontrolled, joint damage may occur. In this context, coxitis is a feared complication. The aim of our study was to determine the prevalence and patterns of hip involvement in Tunisian JIA patients. Methods A retrospective study including children with JIA according to the International League of Associations for Rheumatology (ILAR)) was conducted between 2012and 2021. Sociodemographic data as well as disease characteristics were collected. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Hip involvement was assessed clinical exam and imaging (standard radiograph, ultrasound or magnetic resonance imaging (MRI)). We compared these parameters between the two groups: G1: presence of coxitis and G2: absence of coxitis. Results The study included 40 patients with a male predominance: sex ratio was 1.6. The mean age was 11.1 years-old [3–16]. The mean age at onset of the disease was 18.1 years old [8–30]. The distribution of the different subsets was as follows: polyarticular with rheumatoid factor (n = 1), polyarticular without rheumatoid factor (n = 2), enthesitis-related arthritis (n = 29), oligoarthritis (n = 7), psoriatic arthritis (n = 1). Extra-articular manifestations were found in 21.2% of cases: ocular (n = 4), pulmonary (n = 2) and cardiovascular (n = 1). The mean ESR and CRP was 30.9 mm/h [2–90] and 15.8 mg/l [1–70] respectively. A high ESR or CRP were found in 67% of cases. Hip involvement concerned 70% of the patients and was bilateral in 67.9% of them. Hip radiographs were normal in 50% of cases. Ultrasound was performed in 9 patients and revealed a positive Doppler synovitis (n = 2), a negative Doppler synovitis (n = 7) and joint effusion (n = 2). MRI was performed in 20% of cases and revealed synovitis (67%) and joint effusion (33%). Overall, 79.3% of patients had medical treatment combining NSAIDs and rehabilitation, 39% of the patients had had local infiltration with Hexatrione and only two patients had hip replacement. Hip involvement was not correlated with age at onset (P = 0.2), subtype (P = 0.8), sex (P = 0.7), extraarticular manifestations (P = 0.4). Similarly, there was no correlation between the presence of coxitis and ESR (P = 0.07) as well as CRP (P = 0.5). Conclusion Our study showed that hip involvement is frequent among Tunisian patients with JIA. Although not correlated with disease characteristics, hip involvement should be assessed frequently and carefully.

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AB0720 HIP INVOLVEMENT IN A COHORT OF EGYPTIAN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.712 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1391.2-1391

Author(s):

A. Radwan ◽

H. Alzahrani ◽

Y. Alzahrani ◽

A. Elsaman

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Duration ◽

Age At Onset ◽

Functional Limitation ◽

Joint Damage ◽

Hip Arthritis ◽

Quantitative Score ◽

Harris Score ◽

Total Knee ◽

The Mean

Background:The hip joint is frequently involved in Juvenile Idiopathic Arthritis (JIA). It is more common with polyarticular, systemic and enthesitis-related forms and with severe uncontrolled disease. Chronic hip arthritis leads to irreversible joint damage with marked impairment of quality of life and functional limitation [1]. Unilateral or bilateral hip arthritis occurs in 30- 50% of children with JIA [2].Objectives:The aim of this study is to assess the pattern of hip involvement in a cohort of Egyptian JIA patients in terms of epidemiological aspects, JIA pattern, bilateralism, associated extra-articular manifestations, radiological features, treatment and prognosis.Methods:We included 179 patients who fulfilled the International league against rheumatism criteria for JIA. Epidemiological, clinical, radiological, and therapeutic parameters were assembled and analyzed. Hip involvement was assessed using a semi-quantitative score of pain and tenderness for the hip, CARSH radiographic score of the hip, and Harris functional hip score. JADAS-27 was used for assessment of disease activity.Results:We included 113 girls and 66 boys; with a female: male ratio of nearly 2:1. The age at onset mean was 8.8±3 years (8.9±2.9 for females and 8.6±3.1 for males). The mean age at the study time was 13.3±4.1 years. The disease duration mean was 4.5±2.9 years.Clinically; 20.1% of the cases had hip involvement (12.8% unilateral and 7.3% bilateral), while by imaging, around 30.7% of the cases have hip involvement (19.6% unilateral and 11.2% bilateral). The mean age for cases with hip involvement was 14.1±4.3, compared to 12.9±4 among those with no hip involvement. The mean disease duration for those with hip arthritis (either clinical or by imaging) was 5.5±2.9 years, compared to 4.1±2.9 among those with no hip involvement (Figure 1).Figure 1.Difference between JIA cases with and without hip involvement.The Mean JADAS-27 was 13.5±6.2 and for those with hip involvement was 16.3±6.3. The commonest pattern of JIA with hip arthritis was polyarticular followed by enthesitis-related arthritis. There was a strong significant correlation between JADAS-27 and hip involvement at one hand and Harris score, semi-quantitative score for pain and tenderness at the other hand. Further, disease duration was significantly correlated with hip involvement as well. Among cases with hip involvement, 25% demonstrated destructive changes and 30% showed growth abnormalities.Conclusion:Hip arthritis in JIA is related to polyarticular and enthesitis-related pattern. Longer disease duration, seropositive polyarticular pattern were related to poor prognosis for hip arthritis.References:[1]Singh JA, Cleveland JD. Juvenile idiopathic arthritis is associated with higher healthcare utilization after total knee or hip replacement. Scandinavian journal of rheumatology 2021; 50: 34-9.[2]Rostom S, Amine B, Bensabbah R, Abouqal R, Hajjaj-Hassouni N. Hip involvement in juvenile idiopathic arthritis. Clinical rheumatology 2008; 27: 791-4.Disclosure of Interests:None declared

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P037 Does perinatal history and delivery enhance the risk of hip involvement in Juvenile Idiopathic Arthritis patients? A case-control study

Rheumatology ◽

10.1093/rheumatology/keab722.029 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

Makhlouf Yasmine ◽

Hanene Ferjani ◽

Affes Hassen ◽

Kaouther Maatallah ◽

Dorra Ben Nessib ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Birth Weight ◽

Mode Of Delivery ◽

Hip Dislocation ◽

Normal Growth ◽

Psychomotor Development ◽

Delivery Mode ◽

Cross Sectional ◽

Male Predominance ◽

The Mean

Abstract Background Children are vulnerable to congenital and developmental hip disorders. One of the causes of coxitis among children is juvenile idiopathic arthritis (JIA). Existing data on associations between maternal and early childhood exposures highlighted the potential role of prematurity in JIA [1]. The aim of this study was to compare perinatal history in JIA children with coxitis compared with patients with other causes of hip involvement. Methods We conducted a cross-sectional study including children with JIA complicated with coxitis and patients with other causes of hip involvement. We recorded sociodemographic data and the hip disorder. The mode of delivery, the values of the neonatal birth weight as well as the delivery method (vaginal, cesarean (C) section) were retrieved from medical records. We divided the patients into two groups: G1: JIA patients with coxitis and G2: patients with other causes of hip involvement. We compared delivery mode, as well as perinatal outcomes between the two groups. Results The study included 81 patients. There was a male predominance (59.3% males vs 40.7% females) with a sex-ratio of 1.45. The mean age of diagnosis was 9.9 years [1–16]. The mean disease duration was 9 months [0.1–156]. Hip disorders were distributed as follows: Legg-Calvé-Perthes disease (n = 3), epiphysiolysis of the femur head (n = 30), transient synovitis of the hip n = 7, septic hip (n = 10), tumor (n = 4), hip dislocation (n = 8), hip dysplasia (n = 4), juvenile idiopathic arthritis with coxitis (n = 15). The mean birth weight of the children was 3.4 kg [1.3–9]. About half of the patients had a natural delivery (55.6%) and most of them a face presentation (71.6%). A twin pregnancy was reported only in 2.5% of cases. Childbirth complications were reported in 7.4% of cases: umbilical cord prolapse (n = 1), Meconium aspiration syndrome (n = 1), failure to descend (n = 1), acute fetal distress (n = 3). Most of them had a normal growth and psychomotor development (96% and 97% respectively). There was no statistical difference between the two groups regarding delivery mode and fetal presentation before birth (P = 0.07, P = 0.48 respectively). Similarly, weight at birth was similar between JIA children and patients with other hip involvement (P = 0.52). Conclusion Our study showed that maternal and perinatal history did not differ between JIA patients with coxitis and patients with other causes of hip involvement.

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Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211696 ◽

2018 ◽

Vol 77 (10) ◽

pp. 1426-1431 ◽

Cited By ~ 14

Author(s):

Orazio De Lucia ◽

Viviana Ravagnani ◽

Francesca Pregnolato ◽

Arvena Hila ◽

Irene Pontikaki ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Rheumatoid Factor ◽

Strong Predictor ◽

Power Doppler ◽

Joint Effusion ◽

Synovial Hyperplasia ◽

Individual Patient Level ◽

Grey Scale ◽

Therapy Modification

ObjectivesTo define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.Methods88 consecutive patients with JIA—46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months—underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.ResultsUS was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).ConclusionsUS abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.

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P036 Juvenile Idiopathic Arthritis in adulthood: outcomes of oligo and polyarticular forms?

Rheumatology ◽

10.1093/rheumatology/keab722.028 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

Miladi Saoussen ◽

Makhlouf Yasmine ◽

Fazaa Alia ◽

Sellami Mariem ◽

Ouenniche Kmar ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Transition To Adulthood ◽

Disease Onset ◽

Adult Life ◽

Treatment Modalities ◽

Disease Characteristics ◽

Female Predominance ◽

Tunnel Syndrome ◽

The Mean ◽

International League

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic disease of childhood that can cause major physical disability, impairing patients' ability to lead a normal adult life. The objective of this study was to assess the outcomes of oligo- and polyarticular JIA in adulthood as well as the progression to authentic rheumatoid arthritis (RA). Methods We conducted a retrospective study including adult patients with JIA (diagnosed according to the International League of Associations for Rheumatology [ILAR]). Data collected included age, gender, disease characteristics (JIA subtype, disease duration). The progression to an authentic RA was determined by checking the response to the ACR/EULAR 2010 classification criteria. Results Twenty-eight patients were included in this study. There was a female predominance with a sex ratio of 1.5. The mean age of disease onset was 6 years and 2 months [2–17]. The mean age at inclusion was 29.5 years [18–64]. The frequency of each JIA subtype was as follows: polyarticular with RF + (n = 14), polyarticular with RF- (n = 9), oligoarthritis (n = 5). The polyarticular forms: RF+ and RF- evolved into genuine seropositive and seronegative RA in 71.4% and 66.7% of cases, respectively. Among the oligoarticular JIA subtype, an extension of the disease to a seronegative RA was noted in one patient (20%). Hip involvement was noted in 20% of patients. Carpal tunnel syndrome and elbow arthritis were found in 28.5% and 14.3% of patients, respectively. Regarding treatment modalities and at the time of recruitment, 36.3% of RAs were treated with Methotrexate, and 33% were on biological treatment. Ten percent of the patients dropped out of school because of disease flares and deformities. Conclusion Our study showed oligo- and polyarticular JIA evolves in most of the cases towards an authentic RA causing deformities and handicaps. Earlier management is necessary to allow a better transition to adulthood.

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AB0744 HOW JUVENILE IDIOPATHIC ARTHRITIS PATIENTS PERCEIVE THEIR ILLNESS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3616 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1400.3-1401

Author(s):

K. Maatallah ◽

M. Yasmine ◽

H. Ferjani ◽

W. Triki ◽

D. Ben Ncib ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Rheumatoid Factor ◽

Emotional Response ◽

Illness Perceptions ◽

Illness Perception ◽

Personal Control ◽

Treatment Control ◽

Control Item ◽

The Mean ◽

Child Age

Background:Juvenile idiopathic arthritis (JIA) represents the most common inflammatory rheumatism of childhood. Because of a prolonged course of active disease, many patients experience physical and psychosocial limitations. Illness perceptions involve the personal beliefs that patients have about their illness and may influence health behaviors considerably.Objectives:The present study aimed to investigate the illness perception of patients with JIA.Methods:We conducted a cross-sectional study including children with JIA (according to the International League of Associations for Rheumatology (ILAR)). We recorded sociodemographic data and the subtype of the JIA. To assess a child’s perception of how arthritis affects their life, the Brief Illness Perception Questionnaire (IPQ) was completed by the parent (child age ≤10 years) or by the child (age ≥11 years). The Brief IPQ is a nine-item questionnaire rated using a 0-to10 response scale that assesses cognitive illness representations: consequences (Item 1), timeline (Item 2), personal control (Item 3), treatment control (Item 4), and identity (Item 5). Two of the items assess emotional representations: concern (Item 6) and emotions (Item 8). One item assesses illness comprehensibility (Item 7).Results:The study included 22 patients. The mean age was 15 ± 7 years [4-35], and the mean age at diagnosis was 9 ±3 years [3-14]. There was a female predominance (sex ratio= 2.1). The frequency of each JIA subset was at follows: polyarticular with rheumatoid factor (n= 1), polyarticular without rheumatoid factor (n=3), systemic (n= 2), enthesitis-related arthritis (n=9), oligoarthritis (n= 7), undifferentiated (n=1). Non-steroidal anti-inflammatory drugs were prescribed in 72% of cases, and Cs-DMARDs in 59% of patients. The most-reported causal factor in their illness was a history of traumatism (22%). Perceiving symptoms (identity) were significantly related to being affected by the disease (emotional response) (p= 0.01). Conversely, patients who had personal and treatment control expressed less emotional response (r = −0.7, r=-0.2 respectively). Moreover, those who were concerned about the disease perceived more the consequences of their illness (p=0.09) and understood it more (p=0.029). We also noted significant correlations between personal control and treatment control (p = 0.033). A positive correlation was found between identity as well as consequences and timeline (p=0.011, p=0.024), showing that the perception of chronicity was associated with pain and the burden of the disease.Conclusion:Our study highlighted the importance of assessing illness perception in JIA patients. Patient education programs should be implemented since diagnosis for better disease management.Disclosure of Interests:None declared

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AB0732 JUVENILE IDIOPATHIC ARTHRITIS IN ADULTHOOD

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2658 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1396.2-1396

Author(s):

N. Ben Chekaya ◽

S. Bouden ◽

A. Ben Tekaya ◽

O. Ben Saidane ◽

R. Tekaya ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Disease Activity ◽

Rheumatoid Factor ◽

Joint Destruction ◽

Disease Onset ◽

Failure To Thrive ◽

Overweight And Obesity ◽

Physical Growth ◽

The Mean ◽

Active Disease

Background:Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of unknown aetiology in childhood. Approximately 40- 60% of patients with juvenile idiopathic arthritis (JIA) have continuous or recurrent disease activity extending into adulthood.Objectives:The aim of this study was to evaluate the clinical, biological and radiological course of JIA in adulthood.Methods:A retrospective study including 35 patients was conducted between 2010 and 2019. The patients enrolled met the ILAR criteria for the diagnosis of JIA. Patients with JIA older than 20 years were included. Data regarding sociodemographic features, Physical growth, disease activity, biological and radiological parameters were analysed.Results:Thirty one patients were recruited. The sex ratio was 0.53. The mean age at the time of the study was 38.9 years [20-69]. The mean age of the disease onset was 9 years [3-16]. These patients were assigned to discrete JIA categories: rheumatoid factor positive polyarthritis (47.7%), rheumatoid factor negative polyarthritis (23.9%), oligoarthritis (14.2%), enthesitis-related arthritis (9.5%), and psoriatic arthritis (4.7%).A failure to thrive was seen in 33.3% of patients. Overweight and obesity were found in 38% and 19% of patients, respectively. Biological inflammatory syndrome was noted in 52% of patients, and 65.2% had active disease. Hip involvement was noted in 43.5% of patients and 17.4% of them had a total hip replacement. Sixteen patients had neck pain and the imagining showed an atloid-axoid dislocation in 50% of them. Radiographs showed a joint destruction in 60.9% of patients and a wrist arthritis was the most frequent involvement.Conclusion:Most of our included patients maintain active disease and have functional impairment in adulthood.Disclosure of Interests:None declared

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Preliminary Results of first Belgian Cohort of Juvenile Idiopathic Arthritis: Where Do we Stand in Terms of Quality of Care and Remission?

10.21203/rs.3.rs-133374/v1 ◽

2020 ◽

Author(s):

Céline La ◽

Phu Quoc Lê ◽

Alina Ferster ◽

Laurence Goffin ◽

Bernard Lauwerys ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Quality Of Care ◽

Long Term Outcomes ◽

Disease Characteristics ◽

French Speaking ◽

Das28 Remission ◽

The Mean

Abstract BackgroundJuvenile idiopathic arthritis (JIA) represents a very heterogeneous disease, and our objectives were to describe the first Belgian cohort of children with JIA, assess their disease characteristics and outcome and identify potential markers of prognosis.MethodsThe CAP48 cohort is a multicentric observational study of children with a recent or well-established diagnosis of JIA (naïve or not to treatment at baseline), evaluated every 6 months during a follow-up of 5 to 10 years.ResultsThere were 125 children included in the cohort, composed of 25 naïve and 100 established patients. The patients had a median age of 6.2 and 4.2 years at onset in the naïve and established cohort respectively, with a predominance of female. All subtypes of JIA were represented in both cohorts. The mean DAS28-CRP and JADAS10-CRP at baseline in naïve patients was 2.52 and 6.0 respectively. Uveitis occurred in 19% of patients and was strongly associated with presence of antinuclear antibodies (odds ratio of 6). Fifty-five percent of naïve patients were in remission at 12 months of follow-up according to the ACR criteria and JADAS10 scores, in contrast with 100% achieving DAS28 remission. ConclusionThis first cohort study in Belgium allowed to compare its data to other existing cohorts and to evaluate quality of care in Belgian French-speaking hospitals. Additionally, it highlighted a superiority of JADAS10 over DAS28 to monitor and evaluate remission in JIA. This study also underlined a need for more accurate markers of prognosis to improve treatment and long-term outcomes.

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P031 Adherence with Methotrexate in Tunisian Juvenile Idiopathic Arthritis Patients

Rheumatology ◽

10.1093/rheumatology/keab722.023 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

Hiba Bettaieb ◽

Wafa Triki ◽

Kaouther Maatallah ◽

Hanene Ferjani ◽

Dorra Ben Nessib ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Rheumatoid Factor ◽

Disease Duration ◽

Pediatric Population ◽

Demographic Data ◽

Disease Onset ◽

Weekly Dose ◽

Cross Sectional ◽

High Adherence ◽

The Mean

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in the pediatric population. Methotrexate (MTX) has been considered as the cornerstone of treatment of poly and oligoarticular subtypes of JIA. However, this treatment is supposed to be for long term, which may involve an obstacle for adherence. The aims of the study were to evaluate adherence of Tunisian JIA patients to MTX and to identify factors associated with high adherence to MTX. Methods A cross-sectional study including patients with confirmed JIA diagnosis, according to the International League of Associations for Rheumatology (ILAR) criteria, was performed. Demographic data as well as disease characteristics were obtained from medical records. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. Adherence was measured, for patients under MTX for >3 months, using the 5-item Compliance Questionnaire Rheumatology (CQR5) (1). Patients were divided into two groups: group 1: High adherence (HA) for patients having a CQR5 ≥ 80% and group 2: low adherence (LA) for patients having CQR5 < 80%. A p inferior to 0.05 was considered statistically significant. Results The study included 29 patients (10 males and 19 females) with a mean age at disease onset of 9.1 ± 3.4 years. The mean disease duration was 61 ± 79 months [7–336]. JIA subtypes were in decreasing order of frequency as follows: enthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular without rheumatoid factor (n = 4), Polyarticular with rheumatoid factor (n = 2), systemic (n = 1) and, psoriatic arthritis (n = 1). A biologic inflammatory syndrome was found in 48.3% (n = 14) of cases. The mean ESR and CRP were 20 mm/h ± 11.3 [3–98] and 5 ± 17.8 mg/l [0–56] respectively. Nineteen (65.5%) patients had coxitis. Overall, 55.17% of patients (n = 16) were treated with MTX with a mean weekly dose of 9.2 ± 3.2 mg [5–15]. MTX was orally administrated in all patients. NSAIDs and prednisone were prescribed in 51.7% (n = 15) and 17.2% (n = 5) of cases respectively. The MTX was associated with biological DMARDs in five patients (17.2%). It was about Etanercept in 4 patients and Tocilizumab in 1 patient. Mean CQR5 score was 70.8% ± 18 [25–100]. Only seven patients (43.8%) showed high adherence to MTX. The statistical study revealed no difference between HA and LA in term of gender (P = 0.84), age at disease onset (P = 0.39), disease duration (P = 0.9), prednisone use (P = 0.22), the occurrence of coxitis (P = 0.2), ESR (P = 0.83) and CRP (P = 0.033) rates. Conclusion In this study, less than one half of JIA patients were highly adherent to MTX according to CQR5. Low adherence should be considered before declaring MTX treatment failure.

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HLA-B27 Predicts a More Chronic Disease Course in an 8-year Followup Cohort of Patients with Juvenile Idiopathic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.121257 ◽

2013 ◽

Vol 40 (5) ◽

pp. 725-731 ◽

Cited By ~ 27

Author(s):

Lillemor Berntson ◽

Ellen Nordal ◽

Kristiina Aalto ◽

Suvi Peltoniemi ◽

Troels Herlin ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Age At Onset ◽

Disease Onset ◽

Clinical Signs ◽

Clinical Manifestations ◽

Population Based ◽

Hla B27 ◽

Disease Characteristics ◽

Serological Data ◽

Longterm Outcome

Objective.We investigated associations of HLA-B27 with clinical manifestations and longterm outcome in a near population-based setting among patients with juvenile idiopathic arthritis (JIA).Methods.We studied clinical and serological data from 410 patients with HLA-B27 results among 440 prospectively collected patients with JIA with 8-year followup data in a Nordic database. The study was structured to be as close to a population-based study as possible.Results.HLA-B27 was analyzed in 93% of patients, and was positive in 21% of the cohort, in 18.4% of the girls and in 25.9% of the boys. Boys who were HLA-B27-positive had significantly higher age at onset compared to HLA-B27-negative boys and compared to both HLA-B27-negative and positive girls. This difference in onset age in relation to HLA-B27 was not found in girls. HLA-B27 was associated with clinical signs of sacroiliitis, enthesitis, and tenosynovitis in boys, but not in girls. After 8 years of disease, 46 children (11.2%) were classified as having enthesitis-related arthritis (ERA). Boys with ERA had clinical signs of sacroiliitis more often than girls with ERA. HLA-B27-positive children, as well as children with clinical signs of sacroiliitis, enthesitis, and hip arthritis, had higher odds of not being in remission off medication after 8 years of disease.Conclusion.In this near population-based Nordic JIA cohort we found significant differences between HLA-B27-positive boys and girls in age at disease onset, clinical signs of sacroiliitis, and ERA classification. HLA-B27 was negatively associated with longterm remission status, possibly because of its association with clinical disease characteristics, such as sacroiliitis, rather than being a general marker of persistent disease.

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P032 Methotrexate and hepatic tolerance in Juvenile Idiopathic Arthritis

Rheumatology ◽

10.1093/rheumatology/keab722.024 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

S Miladi ◽

Y El Mabrouk ◽

A Fazaa ◽

L Souabni ◽

M Sallemi ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Rheumatoid Factor ◽

Disease Onset ◽

Prolonged Treatment ◽

Hepatic Toxicity ◽

Inflammatory Drugs ◽

The Mean ◽

Pre Treatment ◽

Seronegative Polyarthritis ◽

Hepatic Cytolysis

Abstract Background Methotrexate (MTX) is considered as the main treatment for some juvenile idiopathic arthritis (JIA) subtypes. The hepatic toxicity of MTX has been reported in numerous studies in rheumatoid arthritis which have shown that prolonged treatment can induce hepatic fibrosis and a disturbance of the liver biologic tests. In patients with JIA, the potential hepatic toxicity of MTX needs to be confirmed. Methods A retrospective study of patients followed for JIA and treated with MTX was conducted. The results of the hepatic assessment looking for cytolysis or cholestasis performed during the pre-treatment assessment and then during regular checks were noted. Results Thirty-nine JIA patients were included. The mean age of disease onset was 8 years [1.5–17 years]. The JIA subtype was systemic in 11 cases, enthesitis related arthritis in 5 cases, rheumatoid factor seronegative polyarthritis in 15 cases and rheumatoid factor seropositive polyarthritis in 2 cases, and oligoarthritis in 2 cases. Patients were treated with low doses of corticosteroids (0.2–0.4 mg/kg) in majority of cases (82%). Non steroid anti-inflammatory drugs were used in 51% of cases. MTX was prescribed as monotherapy in 20 cases, in combination with Sulfasalazine in 6 cases and Anti TNF alpha in 12 cases. MTX has been used on average for 11 years [2 months-26 years]. This drug was stopped for ineffectiveness in 7 cases, for digestive intolerance in 2 cases and in one case for severe hepatic cytolysis after 2 years of treatment with a progressive normalization of hepatic laboratory tests after 6 months. During regular monitoring, no further disturbances of liver function were observed. Conclusion MTX hepatotoxicity appears to be very mild and rare in JIA. These results are reassuring given that MTX is a highly effective treatment in JIA.

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