Abstract: Health Status of Patients with Juvenile Rheumatoid Arthritis at 1 and 5 Years After Diagnosis

Health Status of Patients with Juvenile Rheumatoid Arthritis at 1 and 5 Years After Diagnosis

SUZANNE L. BOWYER, PHILIP A. ROETTCHER, GLORIA C. HIGGINS, BARBARA ADAMS, LINDA K. MYERS, CAROL WALLACE, ROBERT RENNEBOHM, TERRY L. MOORE, PERI H. PEPMUELLER, CHARLES SPENCER, LINDA WAGNER-WEINER, EGLA RABINOVICH, MURRAY PASSO, DANIEL J. LOVELL, KATHERINE MADSON, DEBORAH McCURDY, LAWRENCE ZEMEL, KENNETH N. SCHIKLER, ILONA SZER, PAUL KURTIN, and CAROL LINDSLEY

ABSTRACT.

Objective. To describe the health and functional status of children with juvenile rheumatoid arthritis (JRA) diagnosed in the early 1990s.

Methods. Patients were obtained from the Pediatric Rheumatology Disease Registry, a database of patients seen in pediatric rheumatology centers across the United States. Questionnaires designed to be filled out after retrospective chart review were sent to pediatric rheumatologists caring for children diagnosed with JRA between 1992 and 1997.

Results. We studied 703 patients — 376 with pauciarticular onset (pauci), 232 with polyarticular onset (poly), and 95 with systemic onset JRA (systemic). At 1 year after diagnosis, half of the pauci and systemic patients no longer required medication, compared to 78% of the poly patients; 98% of the patients functioned in Steinbrocker classes I and II. Six percent of pauci, 27% of poly, and 11% of systemic patients had limitations in school function. Nearly 1/3 of poly patients already had joint space narrowing on radiograph. By 5 years after diagnosis, all pauci, 88% of poly, and 70% of systemic patients were in Steinbrocker classes I and II; but 6% of pauci, 28% of poly, and 44% of systemic patients had limitations in school function. Nearly 2/3 of poly and systemic patients had joint space narrowing.

Conclusion. In these children treated prior to the era of biologic therapy, at 5 years after onset, > 25% of poly and nearly half of systemic patients had functional limitations that required modifications in their school schedule. Radiographically evident joint space damage was seen within a year of onset in poly patients, and by 5 years 2/3 of poly and systemic patients had damage. (J Rheumatol 2003;30:394-400)

Key Indexing Terms:

JUVENILE RHEUMATOID ARTHRITIS
FUNCTIONAL STATUS
OUTCOME
MEDICATIONS

From the Pediatric Rheumatology Divisions at Indiana University, Indianapolis, Indiana, Ohio State University, Columbus, Ohio, University of Michigan, Ann Arbor, Michigan, University of Washington, Seattle, Washington, St. Louis University, St. Louis, Missouri, University of Tennessee, Memphis, Tennessee, La Rabida Children's Hospital, Chicago, Illinois, University of Cincinnati, Cincinnati, Ohio, Children's Mercy Hospital, Kansas City, Missouri, Children's Hospital Orange County, Orange, California, Connecticut Children's Medical Center, Hartford, Connecticut, University of Louisville, Louisville, Kentucky, Children's Hospital San Diego, San Diego, California, and University of Kansas, Kansas City, Kansas, USA.

S.L. Bowyer, MD, Professor of Pediatrics; P.A. Roettcher, MSOR, MBA, Research Assistant, Indiana University; G.C. Higgins, PhD, MD, Associate Professor of Pediatrics; R. Rennebohm, MD, Associate Professor of Clinical Pediatrics, Ohio State University; B.S. Adams, MD, Clinical Associate Professor of Pediatrics, University of Michigan; C.A. Wallace, MD, Associate Professor of Pediatrics, University of Washington; T.L. Moore, MD, Professor of Internal Medicine and Pediatrics; P.H. Pepmueller, MD, Assistant Professor of Internal Medicine and Pediatrics, St. Louis University; L.K. Myers, MD, Professor of Pediatrics, University of Tennessee; C. Spencer, MD, Associate Professor of Pediatrics; L. Wagner-Weiner, MD, Assistant Professor of Pediatrics; C.E. Rabinovich, MD, Assistant Professor of Pediatrics, La Rabida Children's Hospital; M. Passo, MD, Professsor of Pediatrics; D.J. Lovell, MD, MPH, Professor of Pediatrics, University of Cincinnati; K. Madson, MD, PhD, Assistant Professor of Pediatrics, Children's Mercy Hospital; D. McCurdy, MD, Subspecialty Staff Physician, Children's Hospital Orange County; L.S. Zemel, MD, Associate Professor of Clinical Pediatrics, Connecticut Children's Medical Center; K.N. Schikler, MD, Associate Professor of Pediatrics, University of Louisville; I. Szer, MD, Clinical Professor of Pediatrics; P. Kurtin, MD, Professor of Public Health, Children's Hospital San Diego; C. Lindsley, MD, Professor of Pediatrics, University of Kansas.

Address reprint requests to Dr. S.L. Bowyer, James Whitcomb Riley Hospital for Children, Room 5863, 702 Barnhill Dr., Indianapolis, IN 46202.

Submitted December 11, 2001; revision accepted August 26, 2002.