PDF(Pubmed)
Abstract：
BACKGROUND: To evaluate long-term outcomes and prognostic factors in patients with juvenile idiopathic arthritis (JIA), presenting as oligoarthritis, who received IAC as the first treatment for their disease.
METHODS: We conducted retrospective study at the University Children\'s Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups.
RESULTS: We included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77).
CONCLUSIONS: Almost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy.
METHODS: We conducted retrospective study at the University Children\'s Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups.
RESULTS: We included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77).
CONCLUSIONS: Almost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy.
摘要：
背景：为了评估幼年特发性关节炎（JIA）患者的长期结局和预后因素，表现为少关节炎，他们接受IAC作为他们疾病的第一种治疗方法。
方法：我们在卢布尔雅那大学儿童医院进行了回顾性研究，斯洛文尼亚,从2015年1月到2023年5月，JIA儿童，临床上表现为少关节炎，接受关节内皮质类固醇注射（IAC）作为初始治疗。收集患者和治疗数据，根据以后的治疗需要，将结果分为三组：不需要治疗，只需要额外的IAC和全身治疗.最后一组根据bDMARD的要求进一步划分。Log-rank(Mantel-Cox)生存分析比较了不同结果组。
结果：我们纳入了109例JIA患者，表现为少关节炎（63%为女性），首先接受IAC治疗的人。IAC的平均年龄是8.0岁,4.3年随访。值得注意的是,38.5％的患者在IAC后不需要额外的治疗，而15.5%只需要额外的IAC。全身治疗,主要是甲氨蝶呤（MTX），对45.9%的患者来说是必要的，平均在IAC后7.8个月内开始。在IAC后的平均2.2年内，22％的人开始了生物治疗。注射关节的数量与生物制剂的需求相关。在最后一次随访中，88.9%患有非活动性疾病。ANA阳性（P=0.049，卡方3.89）和HLAB27抗原存在（P=0.050，卡方3.85）与全身治疗的需要相关。一个8岁以上儿童的亚组，与其他患者相比，ANA和HLAB27阴性患者所需的全身治疗（25.8％）和生物治疗（9.6％）明显较少（p=0.050，卡方3.77）。
结论：需要IAC的少关节JIA患儿中几乎40%没有进展为慢性疾病。年龄更小,ANA阳性，HLAB27的存在是全身治疗的预测因素，而注射关节的数量预测了未来对生物治疗的需求。
方法：我们在卢布尔雅那大学儿童医院进行了回顾性研究，斯洛文尼亚,从2015年1月到2023年5月，JIA儿童，临床上表现为少关节炎，接受关节内皮质类固醇注射（IAC）作为初始治疗。收集患者和治疗数据，根据以后的治疗需要，将结果分为三组：不需要治疗，只需要额外的IAC和全身治疗.最后一组根据bDMARD的要求进一步划分。Log-rank(Mantel-Cox)生存分析比较了不同结果组。
结果：我们纳入了109例JIA患者，表现为少关节炎（63%为女性），首先接受IAC治疗的人。IAC的平均年龄是8.0岁,4.3年随访。值得注意的是,38.5％的患者在IAC后不需要额外的治疗，而15.5%只需要额外的IAC。全身治疗,主要是甲氨蝶呤（MTX），对45.9%的患者来说是必要的，平均在IAC后7.8个月内开始。在IAC后的平均2.2年内，22％的人开始了生物治疗。注射关节的数量与生物制剂的需求相关。在最后一次随访中，88.9%患有非活动性疾病。ANA阳性（P=0.049，卡方3.89）和HLAB27抗原存在（P=0.050，卡方3.85）与全身治疗的需要相关。一个8岁以上儿童的亚组，与其他患者相比，ANA和HLAB27阴性患者所需的全身治疗（25.8％）和生物治疗（9.6％）明显较少（p=0.050，卡方3.77）。
结论：需要IAC的少关节JIA患儿中几乎40%没有进展为慢性疾病。年龄更小,ANA阳性，HLAB27的存在是全身治疗的预测因素，而注射关节的数量预测了未来对生物治疗的需求。
