Disease Activity and Outcome of patients with Juvenile Idiopathic Arthritis

Abstract

Background: Juvenile Idiopathic Arthritis (JIA) is, according to the International League Against Rheumatism (ILAR), defined as swelling within a joint, or limitation in the range of joint movement with joint pain or tenderness, which persists for at least 6 weeks in a child under 16 years of age, observed by a physician, and not due to primarily mechanical disorders or yo other identifiable causes
Objectives:
1. To study the Disease Activity and Outcome in Patients with Juvenile Idiopathic Arthritis, age 2 months to 16 years.
2. To compare JADAS (Juvenile Arthritis Disease Activity Score) based on ESR to JADAS based on CRP in newly diagnosed patients.
Methods: This was a prospective study conducted at the Department of Pediatrics & Neonatology SKIMS Soura over a period of 2 years. Patients were assessed by interview, clinical examination, and lab investigations. Disease Activity and Outcome was measured based JADAS-27.

Results & Conclusion: A total of 17 paptients were enrolled in our study with a minimum age of 3 years, maximum age of 16 years, an average of 11 years, and male: female ratio of 1:1.1. Joint pain & swelling was the most common clinical presentation seen in 94.1% of patients, followed by restricted joint movement in 82.3% and limp in 70.5% of patients. Knee was the most commonly involved joint seen in 70.5% of patients, followed by Ankle I'm 47.1% and Hip in 29.4% of patients. Oligoarthritis was the most common subtype of JIA seen in 76.5% of patients with 64.7% having Oligoarthristis Persistent and 11.8% having Oligoarthristis Extending type of JIA. Systemic Arthritis & Polyarthritis was seen in 11.8% of patients each.
At the initial visit, 5.9% of patients had low disease activity, 41.1% had moderate disease activity and 52.9% had high disease activity. On follow-up, 11.7% had an inactive disease, 17.6% had low disease activity, 35.2% had moderate disease activity and 35.2% had high disease activity. 47% of patients had no change in disease activity, 47% improved while 6% worsened with increased disease activity. Maximum improved was seen in Oligoarthristis Persistent variant of JIA.
Also, we found a close correlation between JADAS based on ESR with JADAS based on CRP.