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Paediatric Rheumatology

 

Ankle arthritis predicts polyarticular disease course and unfavourable outcome in children with juvenile idiopathic arthritis

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
  2. Department of Paediatrics, Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Finland.
  3. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
  4. Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden.
  5. Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.
  6. Paediatric Rheumatology Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  7. Department of Paediatrics, University Hospital of North Norway and Institute of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway.
  8. Department of Paediatrics, Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Finland.
  9. Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology and Department of Paediatrics, St. Olavs Hospital, Trondheim, Norway.
  10. Paediatric Rheumatology Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  11. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
  12. the Nordic Study Group of Paediatric Rheumatology (NoSPeR)

CER8181
2015 Vol.33, N°5
PI 0751, PF 0757
Paediatric Rheumatology

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PMID: 26213158 [PubMed]

Received: 05/12/2014
Accepted : 26/03/2015
In Press: 23/07/2015
Published: 05/10/2015

Abstract

OBJECTIVES:
To evaluate the occurrence, clinical characteristics and prognostic factors associated with ankle arthritis in children with juvenile idiopathic arthritis (JIA).
METHODS:
440 children with JIA were followed for eight years in a prospective Nordic population-based cohort study. Data on remission was available for 427 of these children. Occurrence of clinically assessed ankle arthritis was analysed in relation to JIA category, clinical characteristics and remission data eight years after disease onset.
RESULTS:
In 440 children with JIA, 251 (57%) experienced ankle arthritis during the first eight years of disease. Ankle arthritis was least common in the persistent oligoarticular category (25%) and most common in children with extended oligoarticular (83%) and polyarticular RF-negative (85%) JIA. Children who developed ankle arthritis during the first year of disease were younger at disease onset (median age 4.9 (IQR 2.1–8.8) vs. 6.6 (IQR 2.8–10.1) years, p<0.003) and had more cumulative affected joints at 8-year follow-up (median involved joints 10 (IQR 6-16) vs. 3 (IQR 2-9), p<0.001). The odds ratio for not achieving remission eight years after disease onset, if the ankle joint was involved during the first year of disease was 2.0 (95 % CI:1.3–3.0, p<0.001). Hind-, mid- and forefoot involvements were more common compared to patients without ankle arthritis.
CONCLUSIONS:
In this Nordic population-based 8-year follow-up study, occurrence of ankle arthritis during the first year was associated with an unfavourable disease outcome. We suggest that ankle arthritis should be recognised in the assessment of prognosis and choice of treatment strategy in JIA.

Rheumatology Article