FRI0727-HPR PREDICTORS OF FUNCTIONAL CAPACITY AT 24 MONTHS FOLLOW-UP IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

Abstract

Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and it causes short and long-term disability. Periodic assessment of functional capacity is important to determine the presence or absence of physical disability. Objectives To identify predictive factors of absence of functional disability after 24 months follow-up in a cohort of children with JIA treated at a tertiary referral hospital. Methods Longitudinal, retrospective, analytical, and observational study. Patients who met the following criteria were included in the study between 2013 and 2016:1 to 16 years old, diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR); recently initiated (3 months) care at our clinic, complete C-HAQ (Childhood Health Assessment Questionnaire) records throughout the follow-up period. Patients were treated according to current guidelines for pharmacological and physical therapy. Functional capacity was assessed according to the C-HAQ every 3 months. For the analysis, the C-HAQ scores were divided into 3 categories: 0 - 0.49 (absence of disability), 0.5 - 1.5 (mild to moderate disability), and 1.51 - 3 (severe disability). Univariate comparisons were made to determine the relationship between different variables with the dependent variable “absence of functional disability at 24 months of follow-up”. Independent variables included: disease activity, functional capacity, and treatment-related outcome measures. Those with p values Results Of a total of 148 patients, 122 met the inclusion criteria. Median age: 7.4 years (1-16), 69 female (56.6%). Most patients had Polyarticular (44 patients, 36.1%) or Oligoarticular (33 patients, 27%) JIA. At the beginning of the study, 36 patients (29.5%) did not show functional disability; 70 (57.4%) exhibited mild-moderate disability and 16 (13.1%) severe disability. At 24 months, 73 patients (59.84%) had no disability, 37 (30.33%) moderate/mild disability, and 12 (9.84%) severe disability. In the multiple logistic regression model, performing regular physical therapy (PT) (adjOR 6.83 [95% CI 2.26 - 20.61], p = 0.001), starting PT within 12 months after diagnosis (adjOR 5.45 [95% CI 1.83 to 16.18], p = 0.002), baseline pain Visual Analogue Scale (pVAS, 0-10) less than 3 (adjOR 4.55 [95% CI 1.58 to 13.12], p = 0.005) and adherence to pharmacological treatment (adjOR 15.23 [95% CI 1.86 to 124.8], p = 0.011) were independent factors for not presenting functional disability at 24 months. The area under the model curve was 0.92 (95% CI 0.88 to 0.97). Conclusion The findings of this study reinforce the need of early and regular PT and medical treatment in children with JIA, in order to maintain or improve functional capacity over time.These results are not only statistically significant but clinically relevant since they reflect impact in functional skills in this population. Further studies are needed to confirm these outcomes in larger cohorts with longer follow – up.