Inflammatory Markers and Disease Activity in Juvenile Idiopathic Arthritis
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To evaluate the post treatment changes in disease activity and inflammatory markers over time in longitudinal follow-up involving different subtypes of juvenile idiopathic arthritis (JIA) patients.
This prospective longitudinal study, carried out over a period of 2 y, included JIA patients, both old and new, with high disease activity. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin, CHAQ (Childhood Health Assessment Questionnaire) score and JADAS27 (Juvenile Arthritis Disease Activity score with 27 active joint counts) were estimated at the initial visit, 6 mo, 12 mo and 18 mo of follow-up.
Out of 40 patients, 10 had persistent oligoarthritis, 11 had rheumatoid factor (RF) positive polyarthritis, 8 had RF negative polyarthritis and 11 had systemic JIA. Twenty-one of them were females. Serum ferritin was highly elevated in systemic JIA patients with a range of 750–7712 ng/ml at the initial visit. All three inflammatory markers with disease activity score decreased significantly over 18-mo-period in all four subtypes. At any visit, all these parameters had largest value in systemic arthritis and least in oligoarthritis variety. At 18 mo, all oligoarthritis and polyarthritis cases had low or inactive disease while none of the systemic JIA patients achieved inactive disease. Elevated ESR and serum ferritin was found in all at 18 mo. CRP normalized in some with low or moderate disease activity.
Inflammatory markers and disease activity decreased in all subtypes of JIA with treatment without biologics. Acute phase markers often remain elevated in inactive disease state. Similarly, normal level of an inflammatory marker does not necessarily indicate absence of active disease.
KeywordsDisease activity Acute phase reactant Juvenile idiopathic arthritis JADAS27
- 11.Pouchot J, Ecosse E, Coste J, Guillemin F, French Quality of Life Study Group, Paediatric Rheumatology International Trials Organisation. Validity of the childhood health assessment questionnaire is independent of age in juvenile idiopathic arthritis. Arthritis Rheum. 2004;51:519–26.CrossRefPubMedGoogle Scholar
- 13.Consolaro A, Ruperto N, Bracciolini G, et al. Paediatric rheumatology international trials organization (PRINTO). Defining criteria for high disease activity in juvenile idiopathic arthritis based on the juvenile arthritis disease activity score. Ann Rheum Dis. 2014;73:1380–3.CrossRefPubMedGoogle Scholar
- 22.Kearsley-Fleet L, Davies R, Lunt M, Southwood TR, Hyrich KL. Factors associated with improvement in disease activity following initiation of etanercept in children and young people with juvenile idiopathic arthritis: results from the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study. Rheumatology (Oxford). 2016;55:840–7.CrossRefGoogle Scholar