Galician Medical Journal (Sep 2018)
Remission and Active Disease in Young Adult Patients with Juvenile Idiopathic Arthritis During the Transition Period from Paediatric to Adult Healthcare
Abstract
The objective of the research was to study the frequency of remission in young adults with juvenile idiopathic arthritis during the transition period from paediatric to adult healthcare and factors contributing to its development. Materials and methods. In our study, there were included 165 adult patients from different regions of Ukraine diagnosed with juvenile idiopathic arthritis according to the classification criteria of the International League of Associations for Rheumatology. All the patients were examined in the Oleksandrivska City Clinical Hospital, Kyiv during 2015-2018. There were assessed the presence of rheumatoid factor, anti-cyclic citrullinated peptide, antinuclear antibodies, human leukocyte antigen B27, disease duration, disease activity (the Juvenile Arthritis Disease Activity Score-10 and the Disease Activity Score-28), C-reactive protein, past medical history, quality of life (the 36-Item Short Form Health Survey), the degree of depression (the Patient Health Questionnaire-9) and alexithymia (the 20-item Toronto Alexithymia Scale). In all the patients, bone mineral density was studied using dual-energy x-ray absorptiometry with the evaluation of T- and Z-scores in different regions of the skeleton. The disease was considered inactive at the Disease Activity Score-28 <2.6 and the Juvenile Arthritis Disease Activity Score-10 <1 and <2 for oligoarticular and polyarticular variants of juvenile idiopathic arthritis, respectively. Results and discussion. All the patients were divided into 2 groups: Group I included 136 (82.4%) patients with active disease at the time of examination; Group II comprised 29 (17.6%) patients who achieved remission according to the Disease Activity Score-28 or the Juvenile Arthritis Disease Activity Score-10. In Group I, females prevailed accounting for 58.1% of patients as compared to Group II (31.0%). Disease duration was longer in patients of Group I (p<0.01); however, they did not differ from patients of Group II in age at disease onset and the International League of Associations for Rheumatology variants of juvenile idiopathic arthritis. In Group II, lesions involving more than 3 joints (p<0.01), hand arthritis (p<0.01), symmetric arthritis (p<0.01), enthesitis (p<0.01), spinal pain (p<0.01) were observed less frequently. Fewer patients required joint replacement (p<0.01); the number of deformed and painful joints (p<0.05, p<0.001, respectively) was smaller. However, there was no difference in the level of rheumatoid factor, anti-cyclic citrullinated peptide, antinuclear antibodies, and the presence of human leukocyte antigen B27. The achievement of remission improved physical well-being of patients (the physical component score, p<0.001), although overall mental well-being (the mental component score) did not change according to the 36-Item Short Form Health Survey. In patients with remission, the indicators of physical functioning (p<0.001), role functioning (p<0.001), social functioning (p<0.001), bodily pain (p<0.001), general health (p<0.001), mental health (p<0.001) improved. There was observed a reduction in the level of depression to the normal one according to the Patient Health Questionnaire-9 (p<0.05); however, in both groups, there were observed elevated levels of alexithymia. Both groups did not differ in the frequency of immunobiological therapy prescription; however, the results should be intepreted with caution, since only 5 (17.1%) patients in Group II received immunobiological therapy earlier or at the time of examination. In Group II, patients did not receive glucocorticoids at the time of examination (p<0.001) and earlier more often (p<0.001). Both groups did not differ in both the duration of treatment with disease-modifying antirheumatic drugs and the doses of methotrexate and sulfasalazine. Conclusions. Remission of juvenile idiopathic arthritis was detected in 17.6% of the surveyed young adult patients from different regions of Ukraine during the transition period from paediatric to adult healthcare, that indicated that in most cases the goal of treat-to-target strategy was not achieved. Patients with active disease often developed joint deformities and required their replacement; they had worse physical well-being according to the 36-Item Short Form Health Survey, although mental well-being was affected in both patients with active disease and those with remission, which may be due to high levels of alexithymia in both groups. Patients with active disease had higher levels of depression according to the Patient Health Questionnaire-9, whereas patients in remission showed no depression.
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