Abstract
Objective. To investigate disease course, outcome, and predictors of outcome in an unselected population-based cohort of individuals diagnosed with juvenile chronic arthritis (JCA) followed for 17 years.
Methods. The cohort consisted of 132 incidence JCA cases identified 1984–1986 according to EULAR criteria. At 5-year followup, 129 individuals underwent joint assessment, laboratory measurements, radiographic examination, and medication and functional assessment. At 17-year followup, 86 were examined with joint assessment, laboratory measurements, medication assessment, Health Assessment Questionnaire (HAQ), Keitel functional test (KFT), and Medical Outcomes Study Short Form-36 (SF-36).
Results. At 17-year followup, 40% were in remission, 44% changed subgroups, median HAQ score was 0.0 (range 0.0–1.5), and median KFT was 100 (range 54–100). SF-36 scores were significantly lower compared to a reference group. Thirty-nine percent of those in remission at 5-year followup were not in remission at 17-year followup. In multivariate analyses of variables from the 17-year followup: remission was predicted by remission at 5-year followup (OR 4.8); HAQ > 0 by rheumatoid factor (RF)-positivity at 5-year followup (OR 3.6); KFT < 100 by nonremission (OR 11.3); and RF-positivity (OR 5.6) at 5-year followup; and the SF-36 physical component summary score above average of the reference group by remission at 5-year followup (OR 5.8).
Conclusion. This longterm study of 86 individuals with JCA showed large variability of disease courses and of impaired health-related quality of life. Sixty percent were not in remission at 17-year followup. Longterm outcome was best predicted by and associated with characteristics at 5-year followup rather than those at onset.
- JUVENILE RHEUMATOID ARTHRITIS
- JUVENILE CHRONIC ARTHRITIS
- JUVENILE IDIOPATHIC ARTHRITIS
- PROGNOSIS
- OUTCOME ASSESSMENT
Footnotes
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Supported by grants from The Health and Medical Care Executive Board of the Region Västra Götaland, Rune and Ulla Amlövs Foundation for Rheumatology Research, The Swedish National Rheumatism Association, The Rheumatism Association District of Gothenburg, The Medical Society of Gothenburg, the Region Västra Götaland (agreement for research and education of medical students between the Swedish Government and the university hospitals), and The Health and Medical Care Committee of the Regional Executive Board, Region Västra Götaland.
- Accepted for publication December 19, 2012.