THU0523 Mortality and causes of death among juvenile idiopathic arthritis patients in finland

Abstract

Background Juvenile idiopathic arhritis (JIA) is an inflammatory arthritis that begins before 16 years of age and persists more than 6 weeks. The prevalence of JIA is approximately 1 to 2 per 1,000 children. Only 40–60% of JIA patients had inactive disease at follow-up (1). An increase rate of mortality has been observed in JIA. A follow-up study (1960–1993) in the United States reported early deaths especially in systemic JIA (2). The same was found in an follow-up study in Scotland (3). However two follow -up studies in United States and one study in Germany showed no increased mortality (4,5,6). Objectives To explore mortality rates and causes of death in JIA patients in Finland compared with the general population. Methods All incidents patients with JIA during 2000–2014 were collected from the nationwide register of special reimbursements for disease-modifying antirheumatics drugs, maintained by the Social Insurance Institution of Finland. The National Population Registry identified three age, sex and residence matched controls for each case. Death certificate data up to 2015 were obtained from the Statistics of Finland. Results Altogether 4,180 JIA patients (62% girls) were identified. Mean age at diagnosis was 8.3 years. The average follow-up was 6.6 years (IQR 3.1–10.5). These patients were compared with 12,511 controls. During 28.941 follow-up years, 11 JIA patients (6 girls, 5 boys) and 23 controls (12 girls, 11 boys) died. Mean age at death was 20.3 years (range 11–30) in the JIA patients and 23.1 years (range 9–29) years in the control group. (p=0.17). Cumulative mortality in the patients with JIA was 0.4% (95% Cl 0.2–0.8%) compared to 0.3% (95% Cl 0.2–0.5%) in the controls, hazard ratio was 1.44 (95% Cl 0.70–2.95). Accidents were the most common (54%) cause of death in the patients with JIA, but suicide (39%) in the controls. Alcohol, drug abuse and depression contributed more to deaths in the control (39%) than in JIA group (1%), p=0.053. Conclusions Juvenile idiopathic arthritis is not associated with a higher mortality rate in children and young adults. References Ravelli et al. Juvenile idiopathic arthritis. Lancet 2007;369: 767–78. French et al. Increased mortality in adults with a history of juvenile rheumatoid arthritis. ArthrRheum 2001;44: 523–527. Thomas et al. National study of cause-spesific mortality in rheumatoid arhtritis, juvenile chronic arthritis and other rheumatic conditions: a 20 year follow up. JRheumatology, 2003;30:958–965. Hashkes P et al. Mortality outcomes in pediatric rheumatology in the US. ArthrRheum 2010;62:599–608. Krause et al. Juvenile idiopathic arthritis in Olmsted County, Minnesota 1960–2013. ArthrRheum 2016; 68: 247–254. Minden et al. Long- term outcome in patients with juvenile idiopathic arthritis. ArthrRheum 2002; 46: 2392–2401. Disclosure of Interest None declared