Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years

J Rheumatol. 2013 May;40(5):715-24. doi: 10.3899/jrheum.120602. Epub 2013 Feb 15.

Abstract

Objective: To investigate disease course, outcome, and predictors of outcome in an unselected population-based cohort of individuals diagnosed with juvenile chronic arthritis (JCA) followed for 17 years.

Methods: The cohort consisted of 132 incidence JCA cases identified 1984-1986 according to EULAR criteria. At 5-year followup, 129 individuals underwent joint assessment, laboratory measurements, radiographic examination, and medication and functional assessment. At 17-year followup, 86 were examined with joint assessment, laboratory measurements, medication assessment, Health Assessment Questionnaire (HAQ), Keitel functional test (KFT), and Medical Outcomes Study Short Form-36 (SF-36).

Results: At 17-year followup, 40% were in remission, 44% changed subgroups, median HAQ score was 0.0 (range 0.0-1.5), and median KFT was 100 (range 54-100). SF-36 scores were significantly lower compared to a reference group. Thirty-nine percent of those in remission at 5-year followup were not in remission at 17-year followup. In multivariate analyses of variables from the 17-year followup: remission was predicted by remission at 5-year followup (OR 4.8); HAQ > 0 by rheumatoid factor (RF)-positivity at 5-year followup (OR 3.6); KFT < 100 by nonremission (OR 11.3); and RF-positivity (OR 5.6) at 5-year followup; and the SF-36 physical component summary score above average of the reference group by remission at 5-year followup (OR 5.8).

Conclusion: This longterm study of 86 individuals with JCA showed large variability of disease courses and of impaired health-related quality of life. Sixty percent were not in remission at 17-year followup. Longterm outcome was best predicted by and associated with characteristics at 5-year followup rather than those at onset.

Keywords: JUVENILE CHRONIC ARTHRITIS; JUVENILE IDIOPATHIC ARTHRITIS; JUVENILE RHEUMATOID ARTHRITIS; OUTCOME ASSESSMENT; PROGNOSIS.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age of Onset
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Juvenile / drug therapy
  • Arthritis, Juvenile / epidemiology
  • Arthritis, Juvenile / pathology*
  • Arthritis, Juvenile / physiopathology*
  • Cohort Studies
  • Female
  • Health Status
  • Humans
  • Male
  • Prognosis
  • Quality of Life
  • Recovery of Function
  • Remission Induction
  • Sweden / epidemiology
  • Symptom Assessment
  • Treatment Outcome
  • Young Adult

Substances

  • Antirheumatic Agents