Influence of therapy on the development of long-term articular and extra-articular damages in adult patients with juvenile idiopathic arthritis

Authors

DOI:

https://doi.org/10.15587/2519-4798.2018.143366

Keywords:

juvenile idiopathic arthritis, adults, long-term damages, therapy, glucocorticoids

Abstract

Aim of the research: to evaluate the effect of therapy on the development of articular and extra-articular damages in adult patients with JIA.

Materials and methods: the study included 163 patients aged >18 years, with a JIA according to the ILAR classification. The study did not include patients with disease duration <3 years. The JADAS-10 disease activity, functional capacity (HAQ), articular (JADI-A) and extra-articular (JADI-E) damages of JIA were evaluated. The received therapy, a dose and duration of reception of various medications were analyzed.

Results. JADI-A>1 was detected in 36.9 %, and JADI-E>1 was detected in 30.7 % of patients. Remission was diagnosed in 37 (41.6 %) patients with JIA. Most patients (67 %) had previously taken glucocorticoids (GC). Only 25 % of patients received GC at the time of observation, 28 (17.2 %) received only non-steroidal anti-inflammatory drugs (NSAIDs), 134 (82.2 %) – disease-modifying anti-rheumatic drugs (DMARDs). Biological therapy (BT) was received earlier or at the time of the examination in 23.9 % of patients. JADI-A was more frequently observed in RF-negative polyarthritis (47.1 % of patients vs 15.5 %, p<0.05). Presence of articular damages (JADI-A>1) in patients with persistent oligoarthritis was observed in 16.7 % of patients vs in 31.1 % without long-term joint damages (p<0.05). Extra-articular damages (JADI-E>1) were observed more often in RF-negative polyarthritis (in 36 % of patients vs 20.4 %, p<0.05). In patients without articular (JADI-A<1, 33.0 % vs. 5 %, p<0.05) and extra-articular damages (JADI-E<1, 30.1 % vs 6 %, p<0.05) remission was diagnosed more often. Patients with JADI-A>1 and JADI-E>1 had higher degree of JADAS activity (p<0.05) and a worse functional capacity for HAQ (p<0.05). Patients with long-term extra-articular damages in adulthood were more likely to take GC in history or continued to take GC than patients without extra-articular damages (p<0.01), they received longer GC (p<0.01) and the cumulative dose of GC was higher (p<0.01). However, both groups did not differ in the prescribing BT. Although a difference was found both in the administration of DMARDs, in the duration of treatment with DMARDs and the number of DMARDs assigned sequentially or in parallel in patients with long-term extra-articular damages (p<0.05). Patients with extra-articular damages needed intensification of therapy with BT more often (p <0.05) than patients without JADI-E.

Conclusions: the presence of JIA in childhood leads to the development of articular damages in adulthood. These damages are observed more often in patients with RF-positive and RF-negative poly-arthritic JIA than with enthesitis-associated arthritis JIA and JIA with extended oligoarthritis. Extra-articular damages were developed in RF-positive and RF-negative poly-arthritic JIA more often than in oligoarthritic JIA and enthesitis-associated arthritis JIA. The development of long-term articular and extra-articular damages in adulthood is associated with a history of GC intake (p<0.01) and usage of GC at the time of examination (p<0.01), with a longer duration of GC intake (p<0.01) and a higher cumulative dose of GC (p<0.01). In order to reduce the development of long- term articular and extra-articular damages in adulthood DMARDs and BT should be more often administrated, as well as to avoid long- term use and high doses of GC

Author Biography

Marta Dzhus, Bohomolets National Medical University Tarasa Shevchenka blvd., 13, Kyiv, Ukraine, 01601

PhD, Associate professor

Department of Internal Medicine № 2

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Published

2018-10-03

How to Cite

Dzhus, M. (2018). Influence of therapy on the development of long-term articular and extra-articular damages in adult patients with juvenile idiopathic arthritis. ScienceRise: Medical Science, (6 (26), 20–26. https://doi.org/10.15587/2519-4798.2018.143366

Issue

No. 6 (26) (2018)

Section

Medical Science

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Copyright (c) 2018 Marta Dzhus

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