Pediatric Rheumatology Online Journal → June 2003 → Health-Related Quality of Life, Disease Activity and Outcome Assessments→ Abstract #40

FACTORS AFFECTING ARTICULAR COURSE IN ANA-POSITIVE JUVENILE IDIOPATHIC ARTHRITIS

S. Viola,¹ E. Bozzola,² A. Pistorio,¹ S. Magni Manzoni,² F. Rossi,¹ L. Trail,¹ E. Sala,¹ C. Cugno,² C. Gasparini,² A. Martini,¹ A. Ravelli.¹

¹Pediatria II, IRCCS G. Gaslini, Genova, Italy; ²Clinica Pediatrica, IRCCS Policlinico S. Matteo, Pavia, Italy

Objective. The presence of ANA identifies a subgroup of JIA patients with early onset, predominance of females, asymmetric arthritis and risk of chronic iritis. However, articular course is heterogeneous. We investigated the patterns of joint involvement in ANA-positive JIA patients and compared clinical and laboratory features among patients with different articular courses.
Methods. Consecutive patients fulfilling 1997 ILAR criteria and at least 2 positive ANA determinations in the 1^st 6 mos were studied. Patients with positive rheumatoid factor, enthesitis related arthritis or psoriatic arthritis were excluded. Patients were divided in 3 groups: Group 1: patients with 4 joints involved throughout the disease course (persistent oligoarthritis); Group 2: patients with 4 joints involved in the 1^st 6 mos and subsequent extension to <ge> 5 joints (extended oligoarthritis); Group 3: patients with <ge> 5 joints involved in the 1^st 6 mos (polyarthritis). Clinical and laboratory variables included: sex, onset age, HLA-B27, joints involved in the first 6 mos, uveitis, ocular complications, second line drugs, no. of intraarticular injections, radiographic lesions, variables of JIA activity (MD and parent global assessments, joint counts, and CHAQ) and laboratory indicators of inflammation.
Results. 153 patients were studied: 85 were in Group 1, 34 in Group 2 and 34 in Group 3. The comparison of the 3 group of patients for all clinical and laboratory variables did not show any statistically significant difference, with the exception of the involvement of wrist joint in the first 6 months of disease, which was significantly more common in group 3 (p=0.049).
Conclusion. Our analysis showed that patients with ANA-positive JIA are clinically very similar, irrespective of the pattern of articular involvement. Early involvement of wrist joint may be associated with a more severe course of arthritis in this subgroup of JIA patients.