소아기 류마티스 관절염의 경과 및 예후 인자

Abstract

Objective: To assess the disease course and prognostic factors in juvenile idiopathic arthritis (JIA). Methods: We performed a retrospective study of 136 patients between 1990 and 2000. Patients were classified with respect to the International League of Associations for Rheumatology (ILAR) criteria and prognostic factors were evaluated according to the different subtypes. Poor outcome measures were persistent disease, joint destruction and physical disability. Results: There were 73 males and 63 females and the mean follow up period was 5 years (range 2∼25). Predictors of persistent disease in the systemic onset type were polyarticular involvement, symmetric arthritis, and the presence of active systemic disease at 6 months. A poor outcome in the oligoarticular onset type correlated with polyarticular extension, joint erosion, chronic arthritis (duration＞6 months), relapse, high antinuclear antibody (ANA) titers (＞1:160), persistently high erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Polyarticular extension was associated with chronic arthritis, involvement of small joints at disease onset, and positive HLA-B27. Predictors of persistent disease in the polyarticular type were chronic arthritis, relapse, and the presence of anemia at disease onset. The risk of joint destruction correlated with sex (female＞male), polyarticular involvement, polyarticular extension, chronic arthritis, persistently high ESR or CRP, high ANA titers (＞1:160), relapse, and positive rheumatoid factor. Conclusion: Factors predictive of severity in JIA were identified and prognosis was related more to the disease course than the onset type of JIA. So early diagnosis and more aggressive treatment of patients with poor prognostic features could improve functional outcome.