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STUDY TO DETERMINE THE LONG-STANDING CONSEQUENCES OF SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS AND PREDICTORS OF BIOLOGIC TREATMENT

Muhammad Irfan Zulfiqar, Umer Naqash, Saba Ishtiaq

Objective: The results of systemic juvenile idiopathic arthritis (SJIA) vary from mild disability to mortality. Due to socioeconomic problems, delays in taking certain medications, especially biological agents, can affect the outcome of this disease. This analysis aimed to govern the long-term results and predictors of biological therapy in patients with SJIA. Place and Duration: In the Paediatric unit II of Mayo Hospital Lahore for four-year duration from March 2015 to March 2019. Methods: Patients with SJIA were selected for the study. Data was taken from medical records at the first presentation and during the last clinical visit. The results included disease status, functional impairment and joint damage. Results: Out of 68 SJIA patients, 64 (94%) qualified. Median age at onset (interquartile range) and follow-up were 4.4 (2.9-7.9) and 4.2 (2.3-55.9), respectively. Nine patients (14%) achieved complete remission, while 12 patients (18.8%) survived active disease and 3 died; two of them had macrophage activation syndrome and the other had serious infection. One of the predictors of moderate to severe disability (paediatric health questionnaire ≥ 0.75) was hip involvement (likelihood ratio [OR 27, 95% confidence interval [CI]: 3.20–228.05). In addition, predictors of biological therapy were female (OR 6.4, 95% CI 1.74–23.74), initially at an early age (OR 4.7, 95% CI 1.31–16.66), liver enlargement and spleen (OR 5.9, 95% CI 1.29–27.29) and positive antinuclear antibody (ANA) (OR 6.3, 95% CI 1.19–33.75). In 34.2% of patients, Bone erosion was noted with SJIA. Conclusion: Hip involvement was an important predictor of moderate to severe disability in SJIA, while female gender, younger onset age, liver and spleen enlargement, and positive ANA were predictors of biological therapy. Keywords: Biologic treatment, juvenile idiopathic arthritis, outcomes, predictor, SJIA

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