Long-Term Effects of Articular and Extra-Articular Damage in Adult Patients with Juvenile Idiopathic Arthritis and Different Immunogenic Markers

Abstract

To assess the long-term effects of juvenile idiopathic arthritis in adulthood, unified diagnostic methods for articular and extra-articular lesions should be used which depend on the juvenile idiopathic arthritis variants, the disease activity and treatment. The objective of the research was to compare the clinical manifestations in adult patients with different juvenile idiopathic arthritis-specific immunogenic markers and to evaluate their impact on the long-term articular and extra-articular damage.Materials and methods. We observed 132 young patients with different juvenile idiopathic arthritis variants. According to genetic/immunological markers the following groups were formed: Group I - 38 positive human leukocyte antigen B27 patients; Group II - 13 positive antinuclear antibody patients; Group III - 26 positive rheumatoid factor/anti-cyclic citrullinated peptide patients and Group IV - 55 patients with all negative markers. Long-term effects of juvenile idiopathic arthritis were estimated by the articular juvenile arthritis damage index (JADI-A) and the extra-articular juvenile arthritis damage index (JADI-E). Descriptive statistics, the Student’s T-test, the Fisher’s exact test and Mann-Whitney U-test were performed.Results. 70 women and 62 men with the disease duration of 13.6±9.3 years at the age of 24.3±8.3 years were included into the study: 12 (9.1%) patients with positive rheumatoid factor polyarthritis, 30 (22.7%) patients - with negative rheumatoid factor polyarthritis, 32 (24.2%) patients with persistent oligoarthritis, 19 (14.4%) patients with extendent oligoarthritis, 20 (15.2%) patients with entesitis-related arthritis and 19 (14.4%) patients with systemic arthritis; there were no patients with psoriatic arthritis. There were no differences between groups in age, disease-modifying antirheumatic drug cumulative dose, mean dose of prednisolone and quality of life according to the SF-36. In Group I, the delay in the diagnosis was more than one year (18.6±24.2 months). In this group, less painful (p<0.005) and deformed (p<0.01) joints as compared to Group ІІІ, and higher levels of the ESR and C-reactive protein as compared to Group ІV were found, although the Juvenile Arthritis Disease Activity Score index in childhood was lower (p<0.005) as compared to Group ІІ. They received a lower cumulative dose of the glucocorticoids as compared to Group II (p<0.01), respectively. They had lower (p<0.01) JADI-E as compared to Group II (1.31 ± 1.49) and lower (p <0.01) JADI-A as compared to Group III. In Group III, the diagnosis was made the fastest in comparison with other groups (6.4±8.4 months, p<0.05); more painful joints (p <0.05) and ankylosis (p<0.05) were observed as compared to Group I, JADI-A was significantly higher (p<0.05) in Group III as compared to Group I. The most pronounced JADI-A was found in Group III, while in Group I and Group II, this index was the lowest. JADI-E was the most pronounced in Group II, and the most favorable course was found in Group І and Group ІІІ (p<0.05).Conclusions. Presence of anti-cyclic citrullinated peptide/rheumatoid factor in adults with juvenile idiopathic arthritis has negative impact on joint damage (JADI-A) indicating the need for aggressive therapy in both childhood and adulthood. Presences of antinuclear antibodies are associated with more often extra-articular damages in adulthood as compared to other groups.