 |
|
|
 |
Radiographic and Clinical Outcome in Early
Juvenile Rheumatoid Arthritis and Juvenile Spondyloarthropathy: A 3-Year Prospective Study
ANNE M. SELVAAG, BERIT FLATØ, KNUT DALE, GUNHILD LIEN, ODD VINJE, ANNA SMERDEL-RAMOYA, and ØYSTEIN FØRRE ABSTRACT. Objective. To describe radiographic findings at disease onset and 3-year followup in patients with juvenile rheumatoid arthritis (JRA) and juvenile spondyloarthropathy (JSpA), to assess radiographic progression and its predictors, and to prospectively assess clinical outcome and predictors of persistent disease at 3-year followup. Methods. A total of 197 patients with JRA/JSpA were examined every 6 months for 3 years. Radiographic examination was performed at baseline and 3-year followup of knees and ankles (all patients) and of other joints on clinical indication. Remission was defined as minimum 6 months without medication and no clinical signs of active disease. Results. Radiographic abnormalities were found in 88% of the patients at onset and in 81% after 3 years. Frequency of swelling/osteoporosis decreased and frequency of abnormal growth increased from baseline to followup. Knees, hands, and wrists had most frequently radiographic abnormalities. Radiographic progression occurred in 38% of the patients. Joints with swelling/osteoporosis on radiographs, young age, and a large number of mobility-restricted joints at baseline were predictors of radiographic progression. At 3 years, 26% of the patients were in remission and 75% had been treated with disease-modifying antirheumatic drugs. Reduced well-being, a large number of active joints and negative antinuclear antibody at baseline were predictors of persistent disease after 3 years. Conclusion. After 3 years most patients had radiographic abnormalities and persistent disease. Young age, many affected joints, reduced well-being, and negative antinuclear antibody at onset increased the risk of radiographic progression and persistent disease after 3 years. (First Release June 1 2006; J Rheumatol 2006;33:1382–91) Key Indexing Terms:
JUVENILE RHEUMATOID ARTHRITIS
From the Department of Rheumatology, Rikshospitalet University Hospital, Oslo, Norway. Supported by the Norwegian Foundation for Health and Rehabilitation through the Norwegian Rheumatism Association, the Norwegian Society for Rheumatology, the Olga Imerslund Foundation, the Solveig Amalie Husbys Memorial Foundation, the Grethe Harbitz Legacy, and the Department of Rheumatology, Rikshospitalet University Hospital. A.M. Selvaag, MD, Research Fellow; B. Flatø, MD, PhD, Senior Consultant; K. Dale, MD, PhD, Professor; G. Lien, MD, PhD, Research Fellow; O. Vinje, MD, PhD, Senior Consultant; A. Smerdel-Ramoya, MSc, PhD; Ø. Førre, MD, PhD, Professor. Address reprint requests to Dr. A.M. Selvaag, Department of Rheumatology, Rikshospitalet University Hospital, 0027 Oslo, Norway. E-mail: aselvaag@ulrik.uio.no Accepted for publication February 26, 2006.
|
