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Juvenile idiopathic arthritis in Southeast Asia: the Singapore experience over two decades

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Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objectives

To examine the clinical characteristics, treatment and outcomes of juvenile idiopathic arthritis (JIA) patients evaluated in Singapore and compare those with reports elsewhere.

Methods

Patients with JIA were recruited from our Singapore pediatric rheumatology registry from January 1997 to December 2015. Demographic, clinical, treatment, and outcome data were retrospectively collected. Nonparametric statistics were used to describe the data. Chi-squared, Mann-Whitney U, or Kruskal-Wallis tests were applied to compare differences between groups where appropriate. Multivariate logistic regression analyses were used to identify predictors for clinical parameters.

Results

Two hundred eighty-seven JIA patients with 60.6% males of predominantly Chinese descent were included in the study. The median onset age was 9 years (IQR 5.3–12.6), and the median follow-up duration was 30.1 months (IQR 9.1–61.7). Enthesitis-related arthritis (ERA, 32.8%) followed by persistent oligoarthritis (31.0%) was the most common. Elbow or ankle involvement predicted oligoarthritis extension (OR 15.8 (95% CI: 2.3–108.3, p = 0.005), 8.1 (95% CI: 1.5–45.3, p = 0.017)). JIA-associated uveitis was rare (2.8%) which paralleled the less common positive-ANA rate. Majority of our ERA patients had HLA-B27 (79.8%), together with older age predicted sacroiliitis (OR 4.7 (95% CI: 2.0–11.1, p < 0.05), OR 1.2 (95% CI: 1.1–1.3, p = 0.002)). TMJ involvement was under-reported. Methotrexate remained the most common DMARD used, but 36% of patients required biologics for which ERA and polyarthritis were the majority. Joint damage was rare.

Conclusion

This study highlights geographical and ethnic differences in JIA epidemiology. Compared with reports elsewhere, our JIA population had many unique findings and good functional outcomes requiring regional study validation.

Key points

• ERA is the most prominent JIA subtype in Singapore with high prevalence of HLA-B27.

• JIA-associated uveitis is rare in SEA and is not associated with ANA or JIA-subtypes.

• Elbow and/or ankle involvement at presentation is associated with oligoarthritis extension in our JIA cohort.

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Funding

This work was supported by grants from the National Arthritis Foundation of Singapore and International Leagues of Associations for Rheumatology (ILAR 2011).

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Authors and Affiliations

  1. Department of Pediatric Subspecialties, Rheumatology and Immunology Service, KK Women’s and Children’s Hospital, Kampong Java, Singapore

    Manasita Tanya, Kai Liang Teh, Lena Das & Thaschawee Arkachaisri

  2. Division of Nursing, KK Women’s and Children’s Hospital, Kampong Java, Singapore

    Sook Fun Hoh & Xiaocong Gao

  3. Duke-NUS Medical School, Singapore, Singapore

    Thaschawee Arkachaisri

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  1. Manasita Tanya
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  2. Kai Liang Teh
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  3. Lena Das
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  6. Thaschawee Arkachaisri
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Contributions

All authors contributed to the study conception and design. Data collection and interpretation were performed by MT, KLT, LD, SFH, XG, and TA. Data analysis was done by MT and TA. The funding was granted to TA. The first draft of the manuscript was written by MT and TA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Thaschawee Arkachaisri.

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The SingHealth Centralised Institutional Review Board (CIRB) approved this study and waived the need for informed consent for this database study (CIRB 2019/2274 (2009/919/E)).

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Tanya, M., Teh, K.L., Das, L. et al. Juvenile idiopathic arthritis in Southeast Asia: the Singapore experience over two decades. Clin Rheumatol 39, 3455–3464 (2020). https://doi.org/10.1007/s10067-020-05081-9

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