Longitudinal Health Status from Early Disease to Adulthood and Associated Prognostic Factors in Juvenile Idiopathic Arthritis.

J Rheumatol

From the Unger-Vetlesens Institute, Lovisenberg Diaconal Hospital; Department of Rheumatology, Oslo University Hospital, Rikshospitalet; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo; Section of Psychosomatics and CL-Child Psychiatry, Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet; Department of Patient Safety and Research, Lovisenberg Diaconal Hospital; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.

Published: October 2019

AI Article Synopsis

  • - The study tracked 96 patients with juvenile idiopathic arthritis (JIA) from their diagnosis in childhood to an average age of 25, measuring disease activity, physical functioning, and quality of life over time.
  • - Results showed initial improvements in physical disability and well-being within the first three years, but by the 19-year follow-up, patients experienced increased fatigue and had worse pain and physical health-related quality of life compared to control subjects.
  • - Key early predictors of long-term negative outcomes included pain levels, number of active joints, and physical disability during the first three years of the condition.

Article Abstract

Objective: To describe the longitudinal health status from childhood to adulthood in patients with juvenile idiopathic arthritis (JIA), compare outcomes after 19 years with those of controls, and identify early predictors of physical functioning, pain, and physical health-related quality of life (HRQOL).

Methods: Between 1995-2003, 96 patients with JIA (mean 6.1 ± 4.0 yrs, 67% female) were assessed within 18 months of diagnosis and every 6 months for the next 3 years with measures of JIA disease activity, physical functioning, pain, fatigue, and well-being. They were reassessed a mean of 18.9 ± 1.5 years later (mean age 25.1 ± 4.2 yrs) with measures of physical disability [Health Assessment Questionnaire-Disability Index (HAQ-DI)], pain, fatigue, well-being (visual analog scale), and physical and mental health-related quality of life (HRQOL; Medical Outcomes Study 12-item Short Form Health Survey, version 2).

Results: During the first 3 years, physical disability improved (p < 0.001) and the proportion of patients reporting best possible well-being increased (p = 0.013), while pain and fatigue did not change. At 3- and 19-year followups, patients had similar levels of physical disability, well-being, and pain, but fatigue increased (p = 0.016) and the number of patients with HAQ-DI = 0 decreased (p = 0.001). After 19 years, patients had worse pain and physical HRQOL than controls (p < 0.001). Pain, active joints, and physical disability during the first 3 years were associated with more disability and pain and worse physical HRQOL after 19 years (p < 0.001-0.047).

Conclusion: Patients with JIA reported similar physical functioning, well-being, and pain at 3- and 19-year followups, but more fatigue after 19 years. Patients also had worse health status than controls after 19 years. Pain, active joints, and physical disability were early predictors of unfavorable outcomes.

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Source
http://dx.doi.org/10.3899/jrheum.180948DOI Listing

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