Abstract
Juvenile idiopathic arthritis (JIA) is the most common but extremely heterogeneous group of rheumatic diseases of childhood. There are no reliable, well-researched and published biomarkers for diagnosis or monitoring in juvenile idiopathic arthritis as there are for rheumatoid arthritis (RA) in adults. Biomarkers are not utilized in classifying JIA as they are in adult RA, making the JIA classifications less clinically effective and informative. The situation presents a lost opportunity for early aggressive therapy in JIA patients. Various researchers have used diverse biomarkers anecdotally in JIA and more systematically in RA patients and have drawn inferences on their utility from their experiences. The experience with biomarkers from RA patients cannot necessarily be extrapolated for JIA patients because they are dissimilar diseases. This article reconnoiters the comparative utility of various arthritis biomarkers in adult as well as in JIA patients. In contrast to RA, JIA is in itself a diverse group of arthritis with clinically overlapping subgroups with diverse etiology. The difference in the etiopathogenesis of arthritis subgroups demands identifying subgroup-specific biomarkers for diagnosis/monitoring and subgroup-specific therapies for management. The diagnostic/prognostic value of the individual biomarker could be different in different types of arthritis and in different types of hosts. Understanding the utility of individual biomarkers and careful selection of the assay are important to achieve the best disease outcomes.
Highlights
BackgroundThe most common rheumatic disease in childhood is juvenile idiopathic arthritis (JIA)
The current trends indicate that prevalence and incidence rates are on the rise, which in part may be explained by growing awareness about the diseases and improving diagnostic tools
The diagnostic, prognostic, and predictive therapeutic response studies based on biomarkers is extensive in patients with rheumatoid arthritis (RA) as compared to those with JIA
Summary
The most common rheumatic disease in childhood is juvenile idiopathic arthritis (JIA). Some researchers believe that anti-PAD4 antibodies are disease severity biomarkers and have functional significance in adult patients with RA. Anti-CCP antibodies are more often but not exclusively positive in polyarticular patients, and their presence suggests severe erosive disease in both adults as well as in children [23]. Lower sensitivity makes anti-CCP test a poor screening tool, but if positive in a patient with nonspecific arthritis or protracted arthralgias, it suggests an evolving seropositive/erosive arthritis In another comparative analysis of 59 JIA and 129 adult RA patients, the specificity and sensitivity of anti-CCP antibody were 99.1% and 10.2% in JIA and 98.4% and 55% in RA patients, respectively [26]. Antineutrophil cytoplasmic antibody (ANCA) and atypical (non-myeloperoxidase) p-ANCA can be positive in RA patients and rarely in JIA, but they have no diagnostic or prognostic significance [49]
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