Prevalence Of Juvenile Idiopathic Arthritis Research Articles

The incidence and prevalence of Juvenile Idiopathic Arthritis differs between ethnic groups in England.

Juvenile Idiopathic Arthritis (JIA) is a heterogenous group of rare autoimmune disorders characterised by chronic joint inflammation of unknown aetiology with onset under 16years. Accurate estimates of disease rates help understand impacts on individuals and society, and provide evidence for health service planning and delivery. This study aimed to produce the first national estimates of incidence and prevalence by ethnic group using electronic health records. Data from the Clinical Practice Research Datalink (CPRD) Aurum, a primary care electronic health record database in England, were used to estimate the incidence and prevalence of JIA by ethnic group amongst children and young people aged under 16 years between 2003 and 2018, with cases validated using Hospital Episode Statistics (HES). Chi square was used to test the difference in proportions compared to the ethnic distribution of England. A total of 424 incident cases of JIA were identified, 389 validated using HES records. Incidence of JIA was higher amongst those of White ethnic group (6.2 per 100,000 population) compared to Mixed (3.0 per 100,000), Asian (2.7 per 100,000) and Black (2.9 per 100,000) communities. The ethnic group distribution of cases differed significantly compared to the general population (p < 0.0001). Incidence and prevalence of JIA differs between ethnic groups, and is different from the population. This is likely to be due to a combination of genetic and equity factors. Further research to understand the underlying cause of these differences is important, to enable targeted interventions and appropriate service provision.

E29 Juvenile Idiopathic Arthritis (JIA) in Algeria, from diagnosis to management

Abstract Introduction Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis in children in the world. Objectives to describe a series of 120 children with juvenile idiopathic arthritis (JIA), diagnosed and recruited in the pediatric departments of 5 cities; Sétif and the cities surrounding: Bordj BouArreridj, M'sila, Béjaïa, Batna, between January 1st 2012 to December 31st, 2018 (seven years). The aim is to study the epidemiological, clinical, therapeutic, evolutionary, and the quality of life at presentation, 3rd, 6th and 12th month of follow-up of patients with JIA with evaluation of the incidence and prevalence rate. Materials and methods Our longitudinal, multicentre, and ambispective study (retrospective between 2012–2015, prospective between 2016–2018), allowed us to collect 120 newly diagnosed cases of JIA who fulfilled International League of Association for Rheumatology (ILAR) criteria. Patients were followed up for a duration of 12 months. Results 120 children were studied; females were predominant (54,2%). The average age at diagnosis was 7,46 ± 3,77 years with age at disease onset of ∼6,69 ± 3,65 years and a relatively diagnostic delay of 9,34 ± 13,05 months. Oligoarticular JIA was the most frequent (35,8%), persistent oligoarticular (32,5%) and extensive oligoarticular (3,3%).This is followed by polyarticular JIA (30,8%), Rheumatoid factor (RF) (25,8%) and with RF (5%), and systemic JIA (21,7%), 4.2% psoriatic arthritis (JPsA) and 2.5% enthesitis related arthritis (ERA) with 5% of uncategorized forms. Uveitis was present in 5.8% of cases. The initial inflammatory balance is disturbed with a erythrocyte sedimentation rate (ESR) of 56,32 ± 35,54 mm at the first h, and an average C-reactive protein (CRP) of 42,84 ± 53,76 mg/l, anaemia was seen in more than two thirds of the children (67,5%), thrombocytosis 35,8% and hyperleukocytosis in almost a quarter of children (22,5%). Antinuclear Antibodies (ANA) were present in a quarter of cases (25,8%), RF in 5%, and anti-cyclic citrullinated peptides (anti-CCP) in 3,3% of cases and Human Leucocyte Antigen B27 (HLA B27) was positive in 4.2% of children. An initial activity in non-systemic forms according to the Juvenile Arthritis Disease Activity Score (JADAS10) was moderate in more than a quarter of children, and a strong initial activity according to the American College of Rheumatology (ACR) in more than half of the systemic forms. A moderate initial average functional incapacity assessed by the Childhood Health Assessment Questionnaire (CHAQ) at 1,73 ± 0,52, a moderately altered initial average quality of life Juvenile Arthritis Quality of Life Questionnaire (JAQQ) at 4,07 ± 1,12 and a pain-physician Visual Analogue Scale (VAS) initial mean at 4,98 ± 1,74. The mean annual incidence rate in Sétif during the prospective study was 3,88/100 000 children under 16 and those of the Eastern region including Sétif and the surrounding wilayas (BBA, M'sila, Béjaïa, and Batna) is 2 per 100 000 children under 16. The rate of prevalence of JIA in Sétif is 11,25/100 000 children under 16, and in the East region of the study was 5,80/100 000 children under the age of 16. Medications used were non-steroidal anti-inflammatory drugs (NSAIDs) in (83.3%) followed by disease-modifying antirheumatic drugs (DMARDs) in 65%. Methotrexate in (63,3%), glucocorticoids in (49,2%), and aspirin used in 16,7%, intra-articular corticosteroid injections (IACs) in (15.8%), biotherapy in (19,1%). 27,5% had functional rehabilitation. Evolution at one year is marked by 44.5% disease inactivity with treatment and 31,1% remission. Conclusion JIA is the most common chronic rheumatic disease in children. Nevertheless, it is considered a rare but not exceptional pathology. It is one of the main causes of short-, medium- and long-term disability. Ethics Associate Professor of pediatrics, department of medicine University Setif-Algeria (pediatric center –Setif-Algeria)

High prevalence of sacroiliitis and early structural changes in the sacroiliac joint in children with enthesitis-related arthritis: findings from a tertiary centre in Hong Kong

BackgroundEpidemiological studies have demonstrated a wide, unexplained disparity in the prevalence of juvenile idiopathic arthritis (JIA) subtypes depending on geographical location, ethnicity and other factors. Enthesitis-related arthritis (ERA) is more prevalent in Southeast Asia. Axial involvement in ERA patients is increasingly recognised to occur early in the disease course. Inflammation in the sacroiliac joint (SIJ) observed on MRI seems highly predictive of subsequent structural radiographic progression. The resulting structural damage can have significant impacts on both functional status and spinal mobility. This study aimed to evaluate the clinical characteristics of ERA in a tertiary centre in Hong Kong. The primary objective of the study was to provide a comprehensive description of the clinical course and radiological findings of the SIJ among ERA patients.MethodPaediatric patients diagnosed with JIA attending the paediatric rheumatology clinic from January 1990 to December 2020 were recruited from our registry based at the Prince of Wales Hospital.ResultsIn our cohort, 101 children were included. The median age of diagnosis was 11 years, interquartile range (IQR) 8-15 years. The median follow-up duration was 7 years (IQR 2–11.5 years). ERA was the most prevalent subtype (40%), followed by oligoarticular JIA (17%).Axial involvement was frequently reported in our cohort of ERA patients. 78% demonstrated radiological evidence of sacroiliitis. Among those, 81% had bilateral involvement. The median duration from disease onset to confirmation of radiological sacroiliitis was 17 months (IQR 4-62 months). Among the ERA patients, 73% had structural changes of the SIJ. Alarmingly, 70% of these patients had already developed radiological structural changes when sacroiliitis was first detected on imaging (IQR 0-12 months). Erosion was the most common finding (73%), followed by sclerosis (63%), joint space narrowing (23%), ankylosis (7%) and fatty change (3%). The duration from symptom onset to diagnosis was significantly longer in ERA patients with SIJ structural changes (9 vs 2 months, p = 0.009), comparing with those without.ConclusionWe found that a high proportion of ERA patients had sacroiliitis and a significant number of them had radiological structural changes during early disease. Our findings illustrate the importance of prompt diagnosis and early treatment in these children.

The effect of TNF treatment uptake on incident hospital admission in Western Australia

ObjectiveTreatment strategies for juvenile idiopathic arthritis (JIA) have shifted significantly over the last 20 years. We examined the effect of the introduction of government-subsidised TNF inhibitor (TNFi) treatment on incident hospitalisation for JIA.MethodsWestern Australian (WA) hospital data were used to identify patients < 16 years hospitalised with JIA between 1990 and 2012. Changes in the number of patients with an incident hospitalisation, overall admissions and admissions for joint aspiration were examined using join-point regression TNFi dispensing data from 2002–2012 was used to describe defined daily doses (DDD)/1000 population/day.ResultsWe included 786 patients (59.2% girls, median age 8 years) with a first-time admission with JIA. The annual incident admission rate was 7.9 per 100,000 person-years (95%CI: 7.3, 8.4) which did not change significantly between 1990 and 2012 (annual percentage change (APC): 1.3, 95%CI: -0.3, 2.8). Annual hospital-based prevalence of JIA reached 0.72/1000 in 2012. DDD for TNFi usage rose steadily from 2003 indicating TNFi usage by 1/2700 children in 2012, while overall admission rates (APC 3.7; 95%CI: 2.3, 5.1) and admission rates for joint injections (APC 4.9%; 95%CI: 3.8, 6.0) also increased significantly in that period.ConclusionIncident inpatient admission rates for JIA were stable over a 22-year period. The uptake of TNFi was not associated with lower admission rates for JIA, due mainly to an increase in admissions for joint injection. These results indicate a notable but unexpected change in hospital-based management of JIA since the introduction of TNFi therapy in WA, where hospital-based prevalence of JIA is slightly higher than in North America.

What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis.

The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. IV.

Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study

Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study

37 Subtype frequencies and demographic characteristics of juvenile idiopathic arthritis in Batna, Algeria

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. There is a disparity in the prevalence of Juvenile idiopathic arthritis (JIA) subsets between different geographical areas or ethnic groups. In Arabic and African populations, data describing JIA are scarce. However, the epidemiological studies remain the best tool to understand the disease and to improve its management.ObjectivesTo determine subtype, frequency, demographic and clinical features of JIA in Batna -Algeria- and to compare the findings with other JIA populations worldwide.MethodsA multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA status at the time of enrolment and the latest follow-up.ResultsThe study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. The female to male ratio was 1.83. The median age at diagnosis was 9 years (range 1–16). Forty-six patients (72%) were diagnosed within the first year after disease onset. At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34 oligoarthritis (49.3%), 9(13%) rheumatoid factor (RF) negative polyarticular JIA, 8(11.6%) RF positive polyarticular JIA, 6(8.7%), systemic arthritis, 6(8.7%) enthesitis-related arthritis, 3(4.3%) psoriatic arthritis and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status.ConclusionOligoarthritis was the most common JIA subtype in our study. The RF positive polyarthritis frequency was higher than in literature. Prospective multicentre studies are necessary to better identify the JIA peculiarities in our country.Disclosure of InterestNone declared

34 Subtype frequencies and demographic characteristics of juvenile idiopathic arthritis in Batna, Algeria

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. There is a disparity in the prevalence of Juvenile idiopathic arthritis (JIA) subsets between different geographical areas or ethnic groups. In Arabic and African populations, data describing JIA are scarce. However, the epidemiological studies remain the best tool to understand the disease and to improve its management.ObjectivesTo determine subtype, frequency, demographic and clinical features of JIA in Batna -Algeria- and to compare the findings with other JIA populations worldwide.MethodsA multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA status at the time of enrolment and the latest follow-up.ResultsThe study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. The female to male ratio was 1.83. The median age at diagnosis was 9 years (range 1–16). Forty-six patients (72%) were diagnosed within the first year after disease onset. At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34 oligoarthritis (49.3%), 9(13%) rheumatoid factor (RF) negative polyarticular JIA, 8(11.6%) RF positive polyarticular JIA, 6(8.7%), systemic arthritis, 6(8.7%) enthesitis-related arthritis, 3(4.3%) psoriatic arthritis and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status.ConclusionOligoarthritis was the most common JIA subtype in our study. The RF positive polyarthritis frequency was higher than in literature. Prospective multicentre studies are necessary to better identify the JIA peculiarities in our country.Disclosure of InterestNone declared

36 Juvenile idiopathic arthritis-associated uveitis: a study of 69 cases

BackgroundJuvenile Idiopathic Arthritis (JIA) is the most common rheumatic disease association with uveitis in children. Uveitis is a significant cause of visual morbidity in children with JIA. Geographical variations in the incidence of uveitis in JIA have been reported around the world.ObjectivesThe aim of this study was to determine the prevalence of JIA associated uveitis and its features in Batna -Algeria- and to compare the findings with other JIA populations worldwide.MethodsA multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA medications, JIA status at the time of enrolment and the latest follow-up.ResultsSixty-nine cases of JIA were included. The female to male ratio was 1.8 :1. The median age at diagnosis was 9 years (range 1–16). At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34(49.3%) oligoarthritis, 9(13%) rheumatoid factor (RF) negative polyarticular arthritis, 8(11.6%) rheumatoid factor (RF) positive polyarticular arthritis, 6(8.7%) systemic onset JIA, 6(8.7%) enthesitis-related arthritis, 3 (4.3%) psoriatic arthritis, and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status. Sixty-three patients (91.3%) have benefited from the slit lamp examination. Uveitis was found in 5 patients (7.2%). three of these patients presented with oligoarticular JIA and two presented Polyarticular JIA. There was male predominance (4 boys and 1 girl). All these patients were ANA negative.ConclusionThe observed phenotypic variabilities in JIA associated uveitis underscore the existence of true diversities in disease characteristics across geographical areas. Prospective multicentre studies are necessary to better identify the JIA associated uveitis peculiarities in our country.Disclosure of InterestNone declared

31 Oligoarticular juvenile idiopathic arthritis in a Tunisian pediatric population

Abstract Background Juvenile idiopathic arthritis (JIA) is an acquired autoinflammatory disease characterised by arthritis of unknown origin with onset before age of 16 years. JIA comprises a group of heterogeneous diseases further divided into various categories based on shared clinical presentation, laboratory markers, and disease prognosis. Oligoarticular JIA is the most common group of JIA. The region of Africa constitutes a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of oligoarticular JIA. Objective The aim of our study was to assess the incidence of oligoarticular JIA in children and to describe the clinical and evolutionary characteristics of a series of children presenting with oligoarticular JIA. Results We retrospectively evaluated 192 consecutive pediatric patients with JIA in the emergency and outpatient paediatric department at the children's hospital in Tunisia between January 2005 and December 2021. A total of 95 cases (49,4%) with oligoarticular JIA were included in the final analysis. The incidence of oligoarticular JIA was 4,11 cases per year. The median age of the onset of symptoms was 56 months (range 6–156) and the ratio of males to females was 0,24. we noticed the presence of a family history of autoinflammatory or autoimmune disease in 15.7% of cases. Children were referred to a paediatrician specializing in rheumatic diseases of the child within a maximum of 3 years. These children were referred by an orthopaedist in 31.4% of cases. 82.9% of children were eutrophic at the time of diagnosis while 11.4% were found to having a failure to thrive. We noted that the knees were the most frequently affected joint (48,6%). Oligoarticular JIA with positive autoantibodies represented 64.3% of our patients. The evolution was marked by the occurrence of uveitis in 17.1% of cases. Of the 95 children followed for oligoarticular JIA, 21.4% had an extensive form and 7.1% are currently at the stage of joint deformation. Conclusion The prevalence of JIA in Africa was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in our country was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be higher as compared with the incidence from other regions.

P64 Accurate incidence and prevalence estimates are important for families of children with juvenile idiopathic arthritis

Introduction/BackgroundJuvenile Idiopathic Arthritis (JIA) is a heterogenous group of autoimmune disorders characterised by chronic joint inflammation, affecting children and young people (CYP) under the age of 16. Recent analysis in the UK [1] has provided an update to the estimated incidence and prevalence of JIA.Whilst the policy and health-care benefits of accurate incidence and prevalence rates are understood, this patient- and parent-led qualitative project sought views from parents of CYP with JIA to understand whether knowing accurate estimates of incidence and prevalence are important to them.Description/MethodParents of CYP with JIA, all members of a small online group on social media, were asked whether knowing accurate rates of JIA were important to them, and why. Responses were collated and summarized.Discussion/ResultsWhilst a few respondents felt it did not matter to them what the overall rates of JIA were, focusing instead on their own personal experience with the condition, the majority did want to know and gave consistent reasoning.They advised that, when your child is diagnosed with JIA, it is a very isolating experience. Most people have never heard of the condition before, and being told your child has arthritis is a frightening time (especially if you then become aware of some of the significant long-term effects, such as potential continuation of disease into adulthood and possible joint damage, and the side effects of treatment, and social impacts of the disease [2, 3]. Whilst direct support is available to families affected by JIA (www.jarproject.org/hope), understanding prevalence rates can help reduce mental health burdens on patients and parents and reduce feelings of isolation.Families also advised that they want to know numbers of children with JIA so we collectively can get a better understanding of the cause, the trends, and the possible reasons behind changes. Knowing accurately the numbers of children with JIA can help to raise awareness; current lack of awareness in society and primary care contributes to delays in diagnosis and potentially worse clinical outcomes [4]. In addition they reported the need for appropriate resourcing of paediatric rheumatology and support services, and the political and financial discussions that must take place to enable that to happen need to be supported by evidence.Key learning points/ConclusionOverall, parents do want to know how many other children have JIA. It takes some of the isolation and anxiety away to know you are not alone. It matters because knowing there are other parents in the same situation as you can help reduce anxiety and loneliness. It matters, because knowing there are researchers focussing on JIA helps remind you that work is underway to better understand JIA, its causes, and improved treatments which will eventually lead to improved care for children with the condition. It matters, because it can help target resources appropriately. It matters, because raising awareness is more effective if we know how many people are affected by a chronic condition. And it matters, because as improved treatments are developed we want to be able to see the number of children categorised as having active JIA to reduce and health outcomes for each child to improve.

Association between interleukin-1, interleukin-6, and tumor necrosis factor-alpha polymorphisms and juvenile idiopathic arthritis: a meta-analysis.

In juvenile idiopathic arthritis (JIA), interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-α) are associated with development and progression of JIA. We investigated whether IL-1, IL-6, and TNF-α polymorphisms were associated with susceptibility to JIA. A meta-analysis was conducted on the associations between IL-1α-899 C/T, IL-1β-511 C/T, IL-6-174 G/C, and TNF-α-308 G/A and -238 G/A polymorphisms, and JIA (PubMed and Embase). A total of 27 studies involving 4678 JIA patients and 7634 controls were considered in the meta-analysis. There was no association between the IL-1α-899 C/T, IL-1β-511 C/T, IL-6-174 G/C, and TNF-α-308 G/A and -238 G/A polymorphisms, and JIA in allele contrast or any other genetic models. In subgroup analysis based on subtype, except for the dominant model of TNF-α-238 G/A, systemic JIA was not significantly associated with IL-6 and TNF-α polymorphisms. In Caucasians, the dominant and additive models of IL-1β-511 C/T were significantly associated with JIA (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.09-2.00, P=0.01; OR 1.46, 95% CI 1.05-2.03, P=0.02, respectively). This meta-analysis showed no association between IL-1, IL-6, and TNF-α polymorphisms, and JIA, but the TT genotype of IL-1β -511 C/T was associated with higher prevalence of JIA in Caucasians.

Клинический случай пациентки с увеитом, ассоциированным с ювенильным идиопатическим артритом

The prevalence of juvenile idiopathic arthritis is 0.05–0.6% in different countries, and in the territory of the Russian Federation it reaches 62.3 100 thousand children. The incidence of uveitis associated with juvenile idiopathic arthritis is 10–30%. Uveitis in juvenile idiopathic arthritis occurs in 80–93% of the type of chronic iridocyclitis. In 3–19.6% of cases, recurrent macular edema develops. In order to treat uveitis associated with juvenile idiopathic arthritis, systemic immunosuppressive therapy, local and systemic administration of antiinflammatory drugs are used. Uveitis in juvenile idiopathic arthritis is asymptomatic in the early stages of the disease, so screening ophthalmological examination of children 2–4 times a year is recommended. Purpose. Description of a clinical case of a patient with uveitis associated with juvenile idiopathic arthritis. Material and methods. A clinical observation of a patient with uveitis associated with juvenile idiopathic arthritis was described. Patient Z., 10 years old, underwent a standard ophthalmological examination, ultrasound examination, optical coherence tomography. Results. The patient had a low-symptomatic course of chronic persistent anterior uveitis, the development of cystic macular edema of the left eye. Anti-inflammatory treatment was carried out in the conditions of the academician S.N. Fyodorov Federal State Institution National Medical Research Center “Intersectoral Research and Technology Complex “Eye microsurgery” Ministry of Health of the Russian Federation”, Novosibirsk Branch. The rheumatologist recommended intensification of systemic immunosuppressive therapy. The prescribed treatment made it possible to preserve visual functions, reduce the frequency and severity of the development of relapses of the disease. Conclusions.Uveitis associated with juvenile idiopathic arthritis is a serious pathology, often accompanied by the development of complications, requires a multidisciplinary approach, regular monitoring and timely adequate treatment. Key words: uveitis, macular edema, juvenile idiopathic arthritis.

Медицинская помощь детям с ювенильным артритом в Российской Федерации и в мире

The incidence of rheumatic diseases has been constantly growing during the last 20 years, which necessitates regular assessment of the healthcare quality for these patients and identification of the most significant problems and ways to address them. Juvenile idiopathic arthritis (JIA) is one of the most frequent disabling rheumatic diseases in children. The incidence and prevalence of JIA allow us to use this disorder to evaluate the organization of rheumatology care in general in terms of its accessibility and quality, as well as measures to improve it. This article reviews JIA epidemiology, characteristics and problems of healthcare organization for children with rheumatic diseases in the Russian Federation and other countries. Key words: healthcare organization, rheumatic diseases, health care, juvenile idiopathic arthritis

Identification of musculoskeletal problems using pGALS examination in school going boys in Chennai, India.

ABSTRACTBackground and Aim:pGALS (pediatric Gait Arms Legs Spine) is a useful screening tool in identifying musculoskeletal problems in children. Although musculoskeletal problems are common in children, only a small fraction of them have an underlying serious pathology. There is limited data on this subject from north India but none from south India. Our aim was to identify the prevalence of musculoskeletal problems in school going boys in the local community.Methods:We conducted a prospective cross-sectional study among school boys 7–17 years of age from September 2017 to July 2019, in Chennai. The parents or the boys were asked pGALS screening questions and this was followed by the extended pGALS examination including Beighton’s scoring for hypermobility. If abnormalities in the screening tool were found, the subjects were then referred to a pediatric rheumatologist for further evaluation.Results:A total of 1543 boys were included in this study. Of these 37% of the study group were found to be hypermobile. According to our study, the prevalence of growing pains was 4.6%. Of 2 boys with suspected pathology 1 boy had enthesitis-related arthritis and another had slipped upper femoral epiphysis (SUFE). The estimated prevalence of juvenile idiopathic arthritis (JIA) was 65/100000. According to our study 12.3% of the children were obese.Conclusion:pGALS is a useful tool to screen for musculoskeletal problems in school going boys. The estimated prevalence of JIA was 65/100000. Of them, 37% of the children had hypermobility. Obese children were more likely to complain of musculoskeletal pain (P value 0.00).

Childhood-onset enthesitis-related arthritis leading to nephrotic syndrome due to secondary amyloidosis complicated by acute pulmonary embolism - The domino effect

The prevalence of Juvenile idiopathic arthritis (JIA) in India is 0.001% among the population under 16 years old and 0.00029% among the total population. Of the total JIA population, enthesitis-related arthritis (ERA) constitutes 35% of the cases. In the past, chronic infections, mainly, tuberculosis were the most common cause of AA amyloidosis in India; however, chronic inflammatory arthropathies have become the most common cause of AA amyloidosis in India over the past three to four decades. In 95% of the patients with AA amyloidosis, the kidney is the most affected organ presenting as proteinuria of nephrotic syndrome. The prevalence of AA amyloidosis in JIA is estimated to be 7.7% and 3.1% among the ERA group, making it an infrequent association. This translates to one case of AA amyloidosis secondary to ERA per 1,00,000,00 population in India. Similarly, the incidence of pulmonary thromboembolism in patients with nephrotic syndrome is 7.8%. We present a case of a young male who was diagnosed with JIA-ERA at the age of 13 years with multiple flares in childhood had now developed nephrotic syndrome secondary to AA amyloidosis demonstrated on renal biopsy complicated by acute pulmonary embolism and occult hepatitis B infection. He was managed with anti-tumor necrosis factor inhibitor therapy with a favorable outcome. This is the first such case of multiple rare associations occurring together in a single patient to the best of our knowledge.

Incidence and prevalence of juvenile idiopathic arthritis in the United Kingdom, 2000-2018: results from the Clinical Practice Research Datalink.

ObjectiveThe incidence and prevalence of JIA was last estimated in the UK in 1994. Since then the disease has been reclassified, the specialty of paediatric rheumatology has evolved and there has been a significant shift in disease management with new advanced therapies. This study aimed to provide up-to-date national estimates of this disease.MethodsChildren and young people (CYP) with JIA were identified in the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, which source data from the two most commonly used primary care electronic health record systems in the UK. These databases were combined and the cohort was identified (2000–18) using predefined code lists. Validation was performed through linkage to the England Hospital Episode Statistics. Annual incidence and prevalence rates were calculated and stratified by gender, age group and nation of the UK. Direct standardization to the UK population was performed and 5 year incidence rates were calculated between 2003 and 2018.ResultsThe age-standardized incidence rate was 5.61 per 100 000 population. The age-standardized prevalence rate in 2018 was 43.5 per 100 000. Rates were higher in Scotland compared with England: incidence rate ratio 1.27 (95% CI 1.11, 1.46). The 5 year incidence rates did not change significantly over time.ConclusionsThis study has provided the first contemporaneous estimates of occurrence of JIA in the UK in 25 years. These data provide important estimates to inform resource allocation and health service development for management of JIA.

Результаты пятилетнего мониторинга данных регистра детей с ювенильным идиопатическим артритом в Москве

Objective. To perform a 5-year (2016–2020) monitoring of data from the register of children with juvenile idiopathic arthritis (JIA) in Moscow. Patients and methods. We conducted an observational, descriptive, cross-sectional study involving 1220 JIA patients aged 0 to 17 years. The sample included 783 girls (64.2%) and 437 boys (35.8%). Results. We found that the prevalence of JIA among children aged 0–17 years in Moscow doubled over the last 5 years: from 28.7 to 55.8 per 100,000. There was a minor increase in the primary incidence of JIA: from 9.5 to 12.5 per 100,000. There were some changes in the JIA structure, including a 7% reduction in the proportion of polyarticular seronegative JIA and an 8.3% reduction in the proportion of systemic JIA, along with an 19.4% increase in the proportion of oligoarticular JIA. We observed no significant differences in the structure of basic anti-inflammatory therapy. Approximately 80% of patients received basic therapy; the drug of choice was methotrexate (86.9%). Tumor necrosis factor-α inhibitors (such as etanercept, adalimumab, and golimumab) were the most commonly used biologicals. The frequency of etanercept use increased from 44.9% to 50.7% over 5 years. Conclusion. Regional registers of patients with rheumatic diseases are the most important tool for surveillance, assessment of JIA structure, course, and comorbidities, identification of patients at risk for disability, planning pharmacotherapy, and calculating its cost. Key words: juvenile arthritis, prevalence, incidence, dynamics of the structure of juvenile arthritis, dynamics of basic anti-rheumatic therapy, dynamics of therapy with biologicals

Profile of Juvenile Idiopathic Arthritis in Guinea

Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatoid disease in children. In Sub-Saharan Africa, little data is available on the prevalence of JIA. The objective of our study was to determine the frequency and describe the clinical profile of JIA in Guinean children seen at the Department of Neurology, Academic Hospital, University of Conakry (Guinea). Patients and Method: This was a retrospective study carried out at the Ignace Deen Academic Hospital, Conakry between January 2016 and December 2018. Patients were recruited through the Rheumatology and Paediatrics Department. Results: We collected forty (40) observations of JIA in 22 girls (55%) and 18 boys (45%). The median age at diagnosis was 14 years (range 7 - 18 years), compared to 7 years at onset (range 5 and 13 years). There were 3 cases of systemic arthritis (7.5%), 16 (40%) patients with persistent oligoarthritis, 3 patients (7.5%) that had extensive oligoarthritis, polyarthritis with positive RF in 8 cases (20%) and with negative RF in 4 cases (10%), psoriatic arthritis in 3 cases (7.5%), and enthesitis related arthritis in 2 cases (5%). There was one case of undifferentiated arthritis. A total of 23 (57.5%) received methotrexate, 9 (22.5%) were treated with salazopyrin. Conclusion: The profile of JIA in our study is different from that described in African studies with a predominance of oligoarticular JIA.

Prevalence of Juvenile Idiopathic Arthritis in the Alaska Native Population.

To determine the prevalence and clinical characteristics of juvenile idiopathic arthritis (JIA) in Alaska Native children. Potential cases of JIA were identified by querying administrative data from hospitals and clinics in the Alaska Tribal Health System for codes possibly identifying JIA. Medical record abstraction was performed to confirm criteria met for JIA, demographic and clinical characteristics, and treatment patterns. Individuals age ≤18 years with a confirmed diagnosis of JIA were included. The denominator for prevalence was the 2015 Alaska Area Indian Health Service user population age of ≤18 years. The unadjusted prevalence of JIA in Alaska Native children was 74.6 per 100,000 (age-adjusted 79.0 per 100,000). JIA was more common in females than males (unadjusted prevalence 105.8 versus 45.0 per 100,000). Oligoarthritis was the most common subtype (31% of cases), but polyarthritis and enthesitis-related arthritis were also common (26% and 24% of cases, respectively), with a notably high prevalence of enthesitis-related arthritis. The median age at diagnosis was 9 years. Of the combined cohort with results available, 56% were antinuclear antibody positive, 23% were rheumatoid factor positive, 19% were anti-cyclic citrullinated peptide antibody positive, and 57% had the presence of HLA-B27. Uveitis had been diagnosed in 16% of cases. The prevalence of JIA in Alaska Native children may be higher than the general US population. Enthesitis-related arthritis makes up a higher proportion of cases than in other populations described likely because of the high prevalence of HLA-B27 in this population.