Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort

• Published in: Journal of rheumatology 2002-09, Vol.29 (9), p.1989-1999
• Main Authors: OEN, Kiem, MALLESON, Peter N, CABRAL, David A, ROSENBERG, Alan M, PETTY, Ross E, CHEANG, Mary
• Format: Article
• Language: English
• Subjects: Adolescent; Age Distribution; Age of Onset; Arthritis, Juvenile - diagnosis; Arthritis, Juvenile - epidemiology; Arthritis, Juvenile - therapy; Biological and medical sciences; Canada - epidemiology; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Disability Evaluation; Disease Progression; Diseases of the osteoarticular system; Female; Humans; Inflammatory joint diseases; Male; Medical sciences; Pain Measurement; Prevalence; Probability; Prognosis; Quality of Life; Recurrence; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Distribution; Sickness Impact Profile; Treatment Outcome
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To determine the disease course and outcome in a multicenter cohort of patients with juvenile rheumatoid arthritis (JRA). METHODS: All patients with JRA seen at 3 pediatric rheumatology centers were identified from databases and/or clinic records. Inclusion criteria were a diagnosis of JRA (1977 American College of Rheumatology criteria), a followup period of at least 5 years since onset, and a minimum age of 8 years. Patients were examined and completed a Childhood Health Assessment Questionnaire (CHAQ). Kaplan-Meier curves were constructed to estimate rates of remission, relapse, and arthroplasty. Remission was defined as absence of active arthritis while off treatment for at least 2 years. Outcome measures were active disease duration, CHAQ scores, pain determined by visual analog scales, physician's global assessments, and Steinbrocker functional classifications. Years of education and employment status were ascertained. RESULTS: We studied 392 patients of 652 (60%) who met the selection criteria. The probabilities of remission at 10 years after onset were 37, 47, 23, and 6% for patients with systemic, pauciarticular, RF- polyarticular, and RF+ polyarticular JRA, respectively. The probability of relapse varied from 30 to 100% at 15 years. The probability of arthroplasty varied from 13 to 57% after 15 years of active disease. We found 2.5% of patients assessed were in Steinbrocker Classes III or IV and 6% were in the highest CHAQ score (> 1.5) group. Compared with national statistics, fewer female patients received post-secondary education and unemployment rates for patients 20 to 24 years of age were higher. CONCLUSION: Our results indicate that JRA is a disease that often extends into adulthood. Compared to previous decades, functional outcome has improved; however, the estimated rate of arthroplasty remains very high. Patients with JRA may have difficulty entering the workforce.