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Remission in Juvenile Chronic Arthritis:
A Cohort Study of 683 Consecutive Cases
with a Mean 10 Year Followup
FLAVIO FANTINI, VALERIA GERLONI, MAURIZIO GATTINARA, ROLANDO CIMAZ, CRISTINA ARNOLDI, and ELIDE LUPI
ABSTRACT. Methods. Charts of all patients with JCA were reviewed. Relevant variables were entered into a customized database. The presence of remission (lack of signs of disease activity in the absence of antirheumatic therapy for at least 6 mo) during the disease course and at the last visit was assessed. Results. The cohort included 683 patients, 463 females and 220 males. According to the disease onset, 420 had oligoarticular, 108 polyarticular (23 rheumatoid factor positive), and 88 systemic disease; 67 had a juvenile spondyloarthropathy (SpA). For all 4 categories the mean followup period was about 10 years. At the last visit 224 cases were in remission (32.8%). Remission rate was scarcely influenced by age at disease onset, but differed in the different disease categories. Of the total group of 683 patients, 153 (22.4%) were lost to followup (no control for at least 2 years). For all 4 categories the remission rate at the last visit was higher in patients who had been lost to followup: 42.3% versus 29.0% for systemic onset JCA, 20.8% versus 16.5% for polyarticular onset JCA, 44.7% versus 33.6% for pauciarticular onset JCA, and 66.7% versus 26.8% for juvenile SpA. The probability of attaining remission decreased in proportion to delay in entering the tertiary care center (from 35.7% to 22.8%). The rate of remission reached its peak after 5-10 years of followup, after which the trend reversed. Conclusion. Childhood arthritis achieved remission in only about one-third of our cases, with differences among disease categories based on the diagnosis. (J Rheumatol 2003;30:579-84) Key Indexing Terms:
JUVENILE RHEUMATOID ARTHRITIS
From the Institute of Rheumatology, Centre for Rheumatic Children, Department of Rheumatology, Istituto Ortopedico Gaetano Pini, and Department of Pediatrics, Istituti Clinici di Perfezionamento (ICP), Milano, Italy. F. Fantini, MD, Professor of Rheumatology; V. Gerloni, MD, Dirigente medico di I livello; M. Gattinara, MD, Dirigente medico di I livello; C. Arnoldi, MD, Fellow in Rheumatology; E. Lupi, MD, Fellow in Rheumatology, Institute of Rheumatology, Centre for Rheumatic Children; R. Cimaz, MD, Dirigente medico di I livello, Department of Pediatrics, ICP. Address reprint requests to Dr. R. Cimaz, Clinica Pediatrica, ICP, via Commenda 9, 20122 Milano, Italy. Submitted November 23, 2001; revision accepted September 4, 2002. |