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Persistent Elevation of Fibrin D-Dimer Predicts Longterm Outcome in Systemic Juvenile Idiopathic Arthritis BRADLEY J. BLOOM, ANTHONY J. ALARIO, and LAURIE C. MILLER
ABSTRACT. Methods. We studied 31 children identified from 2 centers. Subjects were assigned a risk category based on their first obtained D-dimer concentration. Risk categories were based on results of our initial study, where normalization of D-dimer in patients no longer taking immunosuppressive therapy predicted good short-term outcome, and persistent D-dimer elevation while taking immunosuppressives predicted bad outcome (radiographic abnormalities, joint replacement surgery, or poor functional class) or a severe systemic manifestation. Outcome was determined at the last followup visit, a minimum of 2 years after measurement of the initial d-dimer level. Results. The 31 children were a mean 16.4 years old at an average of 8.8 years after their initial diagnosis. Ten children had a severe outcome during this period; all 10 had a study baseline risk category of "high." Of the 14 subjects who had a high risk category at study baseline, none had a mild outcome. Conclusion. Our study indicated that a paradigm of risk of severe disease based upon persistent elevation of fibrin d-dimer on first measurements (greater than a mean of 29 months in our initial study and at least 24 months in the additional subjects) is promising to predict poor longer-term outcome in sJIA. A larger prospective study is warranted to substantiate the preliminary data and assess the relative comparative value to other biomarkers and clinical endpoints. (J Rheumatol First Release Dec 1 2008; doi:10.3899/jrheum.070600) Key Indexing Terms:
JUVENILE IDIOPATHIC ARTHRITIS
From the Pediatric Rheumatology Clinic, Hasbro Children's Hospital, and Department of Pediatrics, Brown University Medical School, Providence, Rhode Island, USA. B.J. Bloom, MD, Co-Director, Pediatric Rheumatology Clinic, Hasbro Children's Hospital, Assistant Professor of Pediatrics, Brown University Medical School (current position: Director, Inflammation Therapeutic Area, Pfizer Global Research and Development, New London, CT); A.J. Alario, MD, Co-Director, Pediatric Rheumatology Clinic, Hasbro Children's Hospital, Professor of Pediatrics, Brown University Medical School; L.C. Miller, MD, PhD, Division of Pediatric Rheumatology, Floating Hospital for Children, Associate Professor of Pediatrics, Tufts University School of Medicine, Boston, MA, USA. Address reprint requests to Dr. B.J. Bloom, Pfizer Global Research and Development, 50 Pequot Ave., MS 6025-B3256, New London, CT 06320. E-mail: Bradley.j.bloom@pfizer.com Accepted for publication September 4, 2008.
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