Pediatric Rheumatology Online Journal → June 2003 → Health-Related Quality of Life, Disease Activity and Outcome Assessments→ Abstract #39

EARLY RADIOGRAPHIC DAMAGE IS THE STRONGEST CORRELATE OF LONG TERM RADIOGRAPHIC PROGRESSION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

S. Magni Manzoni,1 A. Pistorio,2 E. Felici,2 S. Buratti,2 C. Novarini,1 A. Buoncompagni,2 C. Malattia,1 M. Bartoli,1 S. Viola,2 A. Martini,2 A. Ravelli.2

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

Purpose. To determine prognostic factors of radiographic progression in JIA.
Methods. 94 JIA patients with bilateral wrist involvement were studied. Wrist radiographs were obtained at first observation (T0), at 1 yr (T1) and at last follow-up (T2), after a mean of 5.0 yrs. Radiographic damage was assessed by measuring radiometacarpal length (RML). Radiographic progression was determined as the change in RML between radiographs at T0-T1 and at T0-T2. Radiographic progression between T0 and T2 was divided by the time interval, thus obtaining the yearly progression rate (YPR). Activity measures: no. active joints (NAJ), MD and parent global assessments, ESR and CRP. Disability measures: no. joints with LROM (NJLROM) and CHAQ.
Results. In the whole cohort, the mean RML at T0, T1, and T2 was 1.19, 1.67 and 1.89, respectively (p0.0001). The mean radiographic progression was 0.46 between T0 and T1 and 0.69 between T0 and T2. The mean YPR in the whole follow-up was 0.11. By univariate analyses, YPR was significantly correlated with male sex (p=0.0003), systemic subtype (p=0.005), and radiographic progression between T0 and T1 (p0.0001). In multiple regression analysis, the strongest correlation with YPR was given by radiographic progression between T0 and T1 (p0.0001), followed by male sex (p=0.0005) and disease duration at T0 (p=0.01). Among the variables measured at T2, the YRS was significantly correlated with severity of RML impairment (p0.0001), NAJ (p0.0001), CHAQ (p=0.0003), and NJLROM (p=0.0003).
Conclusion. In our JIA patients, radiographic damage in the 1st yr was the strongest correlate of long term radiographic progression. Other prognostic factors were male sex and a longer disease duration at 1st observation. At last follow-up, the rate of radiographic progression was significantly correlated with the degree of disability and continued joint inflammation.