Natural course and prognosis of patients with juvenile rheumatoid arthritis

Background: Juvenile rheumatoid arthritis is the most common childhood rheumatological disease that the most important feature of it is idiopathic chronic inflammatory synovitis beside clinical signs (1,2). We tried to define the damage of this disease for body functiones and life quality with estimating of functional current status of patients. Therefore it is possible to show the different and common features of juvenile rheumatoid arthritis in other societies.Aim: To determine the demographic, clinical and laboratory features of patients with juvenile rheumatoid arthritis in Cukurova area and present the results of long term follow up.Material and Method: A retrospective study was done in patients diagnosed with International League of Associations for Rheumatology criteria for juvenile rheumatoid arthritis (3). 124 hospital records were investigated retrospectively and 97 patients being followed for one year were included to the study. Gender, family history, age at diagnosis, duration of disease, following period, medication, complet blood count, erythrocyte sedimentation rate, C reactive protein, anti nuklear antibodies, rheumatoid factor and Human Leukocyte Antigen-B27 were recorded. Childhood health assesment questionaire-disability index Turkish version (1), Visual Analog Scala-Patients and Doctors scores were measured. Disease activity score which was at first diagnosis and the last visit was evaluated and compared.Results: 36 (37,1 %) of patients were male and 61 (62,9 %) of patients were female. Approximately female to male ratio was 3:2. 35 (36,0 %), 38 (39,1 %), 8 (8,2 %) and 7 (7,2 %) of patients had oligoarticular, poliarticular, systemic juvenile rheumatoid arthritis and enthesitis-related arthritis, respectively. Other arthritis were 9 (9,4 %). The mean of beginning age of juvenile rheumatoid arthritis was 5,6±3,9 years and mean age at diagnosis was 7,05 ±4,03 years. Mean following period was 5,1±3,2 years. Anti nuklear antibodies was positive in 12 (12,4 %) of patients. The highest value of anti nuclear antibodies was seen in oligoarticular juvenile rheumatoid arthritis. 3 (14,5 %) of patients had positive human leukocyte antigen-B27. 13 (13,4 %), 56 (57,7 %) and 28 (28,9 %) of patients were at remission, partial remission and active disease, respectively. According to childhood health assesment questionaire- disability index, 53,1 % of patients had no disability. 17,7%, 21,9% and 7,3% of patiens had mild, moderate and severe daily functional activities, respectively.Conclusion: Similar and different results other countries from were clinically obtained while comparing with our Juvenile rheumatoid arthritis patients located in Cukurova region and both other societies and regions of Turkey.Low uveitis numbers and anti nuclear antibodies positivity were reported with different distribution for subtypes and through duration of the disease in our study. An accurate correlation was found between patients with high disease activity score at diagnosis and activation of the disease. Prognosis was good for oligoarticular juvenile rheumatoid arthritis and enthesitis-related arthritis. Our study also showed that genetical and environmental factors may have an important role during the course of juvenile rheumatoid arthritis.Key words: children, Juvenile rheumatoid arthritis, prognosis, remission