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Predictors of relapse in patients with oligoarticular juvenile idiopathic arthritis in remission off medication

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Abstract

The aim of this study was to evaluate the predictors of relapse in patients with oligoarticular juvenile idiopathic arthritis (oJIA) who achieved clinical remission off medication. This retrospective observational study was conducted between June 2009 and July 2022 in 126 patients with oJIA who achieved remission off medication. The relationships between relapse status and demographic, clinical and laboratory findings, and treatment details were evaluated using electronic medical records. Of the 126 oJIA patients who achieved remission off medication, 85 (67.5%) were female. Relapse occurred in 31 patients (24.6%) with remission off medication after a median of 18 months (IQR 7–26). No statistically significant relationship was found between gender, age at diagnosis, oJIA subtype, number of joints, ANA, ESR, CRP level, initial Juvenile Arthritis Disease Activity Score and relapse in oJIA patients who achieved remission off medication (p = 0.66, p = 0.25, p = 1, p = 0.54, p = 0.29, p = 0.59, p = 0.95 and p = 0.52, respectively). There was a statistically significant relationship between the number of intraarticular corticosteroid injections (IACIs) and relapse (p = 0.01). Patients who underwent IACI 2–3 times had more relapses than those who never underwent IACI and those who underwent IACI only once (p = 0.01, p = 0.02, respectively). A relationship was found between the length of follow-up and relapse in patients with oJIA who achieved remission off medication (p = 0.035).

   Conclusion: In oJIA patients who achieve remission off medication, the probability of relapse increases in patients who need ≥ 2 IACI during the period until remission. The length of follow-up period is associated with the probability of relapse.

What is Known:

• Approximately one-fourth of oJIA patients who are in remission off medication have relapse.

• There is a need for markers that can predict the risk of relapse in oJIA patients who achieve remission on or off medication.

What is New:

• The possibility of relapse should be considered in patients with oJIA who need ≥ 2 IACIs until achieving remission off medication.

• The relapse rate may increase as the follow-up period prolongs in patients who achieve remission off medication.

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Authors and Affiliations

  1. Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Bilkent, Ankara, Turkey

    Melike Mehveş Kaplan, Tuba Kurt, Merve Cansu Polat, Müge Sezer, Zahide Ekici Tekin, Elif Çelikel, Vildan Güngörer, Nilüfer Tekgöz, Cüneyt Karagöl, Serkan Coşkun, Nimet Öner & Banu Çelikel Acar

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  1. Melike Mehveş Kaplan
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  2. Tuba Kurt
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Contributions

All authors made substantial contributions to the conception or design of the work, have approved the final manuscript, and takes full responsibility for the manuscript. MMK, BCA reviewed and revised the manuscript, TK, MCP, MS, ZET, EC, VG, PNAT, CK, SC, NO and BCA contributed to the writing of the manuscript.

Corresponding author

Correspondence to Melike Mehveş Kaplan.

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Ethics approval

The study was approved by the Ankara City Hospital, ethics committee before the study (Issue No: E2-22-2047). The study is in accordance with the ethical standards of institutional research committee and with the 1964 Helsinki declaration and its later amendments. Due to the retrospective design of the study, no patient consent was obtained.

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Communicated by Peter de Winter

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Kaplan, M.M., Kurt, T., Polat, M.C. et al. Predictors of relapse in patients with oligoarticular juvenile idiopathic arthritis in remission off medication. Eur J Pediatr 182, 4557–4564 (2023). https://doi.org/10.1007/s00431-023-05123-9

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