A STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME IN JIA: IN A TERTIARY CARE TEACHING MEDICAL COLLEGE HOSPITAL.

Balameena Selvakumar, Aravindan Ambigapathy

Abstract


Introduction: Juvenile idiopathic arthritis (JIA) is a chronic debilitating disease1.The outcome of the disease has much changed since the
introduction of newer therapies.
Aim: To find out the clinical profile, functional outcome and the radiological score in a cohort of JIA patients.
Materials and Methods: This study included 30 children with JIA attending Institute of Rheumatology (IOR), Madras Medical College, who
fulfilled the classification criteria for JIA as per ILAR and with significant wrist involvement.2The study period was January 2012 to December
2013. History, clinical examination, musculoskeletal examination, laboratory investigations, outcome indices (including CHAQ) and radiological
indices (Poznanski's score) were done for all patients. The study was done after Institutional Ethical committee approval and informed consent
from patients and parents.
Results: The mean age of the patients in Oligoarticular was 5.17±2.34, in polyarticular 8.01±3.04 and in systemic JIA was 6.3±2.301. In this
cohort, 14 had Oligoarticular type, 10 had polyarticular type and 6 had systemic JIA type. Boys were 14 in number and 16 were girls. The worse
Pozanski score was seen in 14.28% of Oligoarticular type, 30% in polyarticular type and 33.33% in systemic JIA type. CHAQ improved during the
study period in majority of domains of Oligoarticular type ( p value of 0.6) and in polyarticular type( p value was 0.03). In systemic JIA type, the p
value for CHAQ was 0.133. There was also improvement in the acute phase reactants and functional outcome.
Conclusion: The outcome of JIA is dependent on early diagnosis, appropriate therapy and duration of therapy. Oligoarticular type has the best
overall prognosis and good functional outcome. Children with systemic JIA have the most severe disease and had poor functional outcome. Nearly
33.3% of systemic JIA had worse Pozanski score. This study shows that CHAQ reflects the severity of disease and the prognosis of JIA depends on
the type of JIA functional outcome of the patients correlates with acute phase reactants in polyarticular and systemic onset J I A Radiological score
can be an useful tool for assessing the prognosis of the patients but larger cohort and longer duration would add more to our knowledge in this
aspect.


Keywords


CHAQ: childhood health assessment questionnaire. JIA: juvenile idiopathic arthritis. ILAR: international league against rheumatism.

Full Text:

PDF

References


Clinical outcome and long-term Remission in JIA. Glerup M, Herlin T, Twilt M. Current Rheumatology Reports 2017 Nov 4; 19 (12) 75.

Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban 1997. Petty RE, Southwood TR, Baum J et al. The Journal of Rheumatology 2000. June; 27(6): 1568.

Prognostic factors for radiographic progression, radiographic damage and disability in juvenile idiopathic arthritis. Magni-Manzoni S, Rossi F, Pistorio A, Temporini F et al. Arthritis and Rheumatism 2003 Dec; 48(12): 3509-17.

Disease activity and disability in children with juvenile idiopathic arthritis one year following presentation to paediatric rheumatology. Results from the Childhood Arthritis Prospective Study. Kimme L., Hyrich Sham D. Lal Helen E. Foster Judith Thomton et al., Rheumatology. Volume 49, Issue 1, 1 January 2010, pages 116-122.

Outcome Measures in Pediatric Rheumatology .Sujata Sawhney & Manjari Agarwal, Indian J Pediatr (2010) 77:1183–1189

Carpal length in children- A useful measurement in the diagnosis of RA and some congenital malformation syndromes. Radiology December 1978 129: 661- 668. Andrew K. Poznanski, Ramiro J. Hernandez et al

Physical function assessment tools in Paediatric Rheumatology. Lakshmi Nandini Moorthy, Margaret GE Peterson, et al. Paediatric Rheumatology Online Journal. 2008; 6: 9.

Systemic onset juvenile idiopathic arthritis: a retrospective study of 80 consecutive patients followed for 10 years, C. Lomater, V. Gerloni, M. Gattinara, et al., J. Rheumatol. 27 (2) (2000) 491–49.

Correlates of disablement in systemic onset juvenile chronic arthritis. A cross sectional study: Scand. J. van der Net, W. Kuis, A.B. Prakken, et al J. Rheumatol. 26 (3) (1997) 188–196.

Outcomes following onset of Juvenile Idiopathic inflammatory arthritis: Frequency of different outcomes. N Adib et al, Rhuematology Vol 44, Is 8, Aug 2005-pg 995.

Comparative epidemiology of the rheumatic diseases in children. K. Oen. Curr Opin Rheum. 12 (2000) pg 410.

Juvenile idiopathic arthritis. Ravelli A, Martini A: Lancet 369 (9563):767–778, 2007

Long-term outcomes and predictors of outcomes for patients with juvenile idiopathic arthritis Kiem Oen MD, FRCPC Best Practice & Research Clinical Rheumatology Volume 16, Issue 3, July 2002, Pages 347-360

Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009.Leslie R. Harrold et al .J Rheumatol. 2013 Jul; 40(7): 1218–1225.

Epidemiology of juvenile idiopathic arthritis in Oman. Reem Abdwani et al. Pediatr Rheumatol Online J. 2015; 13: 33

Worldwide prevalence of juvenile arthritis—why does it vary so much? J. Rheumatol. PJ Manners, C.Bower et al, J. Rheumatology 29 (2002) pg 520

Does Systemic- onset juvenile idiopathic arthritis belong under juvenile idiopathic arthritis ? A V Ramanan et al, Rheumatology, 2005 Vol 44, no 11, pg 1350-1353.

Epidemiology of juvenile idiopathic arthritis in Alsace, France. S Danner et al, J Rheum 33 (7) (2006) pg 1377-1381.

Study of clinical spectrum of juvenile idiopathic arthritis in children in a tertiary referral hospital. Viswanathakumar H M et al. Curr Ped Res. 2014; 18 (1) : 21-25

Inflammatory cytokine responses in juvenile chronic arthritis. M Rooney, J David et al, British J of Rheum.1995. Vol 34.No 5. Pp 454- 460.

New insights in systemic juvenile idiopathic arthritis—from pathophysiology to treatment M. Frosch J. Roth et al, Rheumatology, Volume 47, Issue 2, 1 February 2008, Pages 121–12

Nutritional anemia in Young Children with focus on Asia and India Prakash V et al.Indian J of community Medicine 2011 Jan-Mar 36 (1) : 8-16

Analysis of juvenile idiopathic arthritis associated Uveitis in India over the last 16 years. Indian Journal Ophthalmology 2007 May-Jun; 55(3): 199-202. Sudarshan.S. et al

ANA positivity in juvenile idiopathic arthritis: make a difference in a Colombian children population? Pediatric Rheumatology2014,12 (Suppl 1) Clara Malagon et al

New insights in systemic juvenile idiopathic arthritis—from pathophysiology to treatment M. Frosch J. Roth et al, Rheumatology, Volume 47, Issue 2, 1 February 2008, Pages 121–12

Juvenile Idiopathic Arthritis: Diagnosis and Treatment.Gabriella Giancane et alRheumatol Ther. 2016 Dec; 3(2): 187–207.

Arthritis and Rheumatology vol.55, no. 6, Dec 15, 2006, pp 843-849. Corrleation between juvenile idiopathic activity and Damage measures in early advanced and long standing disease. Elena Palmisani et al.

Psychometric characteristics of outcome measures in JIA- A systemic review Heather A. et al, Arthritis Care and Research. 64.4-2012:554-562

Using Patient Reported Outcome Measures to Capture the Patient’s Voice in Research and Care of Juvenile Idiopathic Arthritis.Aimee Hersh, MD,et a, Rheum Dis Clin North Am. 2016 May; 42 (2) pg 333-346

Outcome and predictive factors in juvenile rheumatoid arthritis and juvenile spondyloarthropathy. Flato B et al .J Rheumatol.1998.25.366–75

Early predictors of outcome in juvenile idiopathic arthritis. A Ravelli et al. Clin Exp Rheum 2003; 21 suppl.31- S89-s93.

Correlates of Disablement in Polyarticular Juvenile Chronic Arthritis- a cross-sectional study. J Van Der et al. Rheumatology, Vol 35, Issue 1, Jan 1996, pg 91-100.

Early predictors of poor functional outcome in systemic-onset juvenile rheumatoid arthritis. Spiegel. LR. Schneider R, Arthritis Rheum. 2000.43: 2402-9

Nordal EB, Zak M, Aalto K, et al Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting. Annals of the Rheumatic Diseases 2012; 71:1122-1127.

Predictors of 2 year outcomes of juvenile idiopathic arthritis in a multicenter Canadian cohort: the ReACCh out experience, Natalie J Shiff et al. Pediatr Rheumatol Online J. 2012; 10(Suppl 1): A40.

Outcome Measures in Pediatric Rheumatology Sujata Sawhney & Manjari Agarwal, Indian J Pediatr (2010) 77:1183–1189

Health related quality of life survey about children and adolescents with juvenile idiopathic arthritis. Amine B Rheumatology International. 2009 Jan; 29(3):275-9

S.Viola 2005 Development and validation of a clinical index for assessment of long term damage in juvenile idiopathic arthritis. Arthritis and Rheumatism. Vol. 5. No.7,pp 2092-2102


Refbacks

  • There are currently no refbacks.