Profile of anemia in children with juvenile idiopathic arthritis

Abstract

Background: Anemia is one of the commonest extra-articular manifestations or complications associated with juvenile idiopathic arthritis (JIA) and is generally seen to corelate with disease-duration and disease-activity. Aim of the study was to find out the prevalence of anemia, its etiological spectrum and severity in children suffering from JIA, to determine its correlation with disease-activity and disease-duration and assess the change in the status of anemia after initiating cause- specific treatment in addition to disease-specific treatment in a follow-up period of 3 months. Methods: This prospective longitudinal observational study was conducted in a tertiary care teaching hospital from July to December 2022. Patients of JIA were recruited through purposive sampling stratified by disease activity based on juvenile arthritis disease activity score (JADAS) 27 score and anemia categorized by World Health Organization (WHO) criteria. Results: A total of 64 children were included in the final analysis. Mean age of patients was 8.19 years (SD 2.34 years), male: female ratio being 1.2:1. 78.12% were anemic, with 59.37% being moderately anemic. Overall, anemia-of-chronic-disease (ACD) was the most (48%) prevalent type of anemia, followed by iron-deficiency-anemia (IDA) at 28%, followed by a combination of both IDA and ACD (12%). Remaining 12% was attributed to other causes of anemia. Mean-hemoglobin at 1st visit was found to decrease with increase in disease duration. Significant moderate linear negative correlation was found (r=-0.54) (p<0.001) between mean-hemoglobin-at-1st-visit and mean-disease-activity-at-1st-visit. Significant rise in hemoglobin level after initiation of cause-specific treatment with disease-specific treatment was also observed in this study. Conclusions: Anemia associated with pediatric rheumatological conditions has significant negative impact on the disease process. Prompt diagnosis of anemia, denoting its type and severity, and thereby treating anemia alongside disease-specific treatment, significantly improves the patient outcome.