Juvenile idiopathic arthritis: a clinical audit

Abstract

Background Juvenile idiopathic arthritis (JIA) is an autoimmune, inflammatory noninfective joint disease that includes different disease subtypes that are characterized by the onset of arthritis starting before the age of 16 years with symptoms lasting at least for 6 weeks. Objective The aim of this study was to evaluate the compliance of healthcare providers at the Pediatric Rheumatology Unit, Assiut University Children's Hospital, to the 2011 American College of Rheumatology recommendations for treatment of JIA. Patients and methods The study was conducted on 50 patients who were younger than 16 years and diagnosed as having JIA at the Pediatric Rheumatology Unit, Assiut University Children's Hospital, to assess compliance of the unit's healthcare providers to American College of Rheumatology recommendations for treatment of JIA. Results The patients were grouped according to age into two groups: from 1 to 7 and 8 to 16 years. Polyarticular JIA was the most common type among studied cases followed by systemic-onset JIA. All studied cases presented with arthritis at the time of diagnosis. Complete blood count and erythrocyte sedimentation rate were done for all studied cases at the time of diagnosis. Rheumatoid factor was done for 84%. The most common complications among the studied group were those related to treatment. NSAIDs and corticosteroids were the most common drugs used. Conclusion Treatment of JIA includes pharmacological and nonpharmacological interventions and surgical treatment. Pharmacological treatment includes NSAIDs, steroids, disease-modifying antirheumatic drugs, and biological agents. The degree of disease activity and the presence or absence of features of poor prognosis greatly affect onset of complications and treatment of JIA. Nonpharmacological interventions include psychosocial therapy, nutrition, physical and occupational therapy, lifestyle factors, and home remedies. Through this study, some defects were found. First, there was deficiency in data recording. Second, there was also deficiency in laboratory (mainly rheumatoid factor and antinuclear antibody/anti-double stranded DNA) and radiological workup. Moreover, nonpharmacological therapy and surgery were not considered. Lastly, there was deficiency in regular follow-up of safety drug monitoring.