Background/Purpose: The impact of juvenile idiopathic arthritis (JIA) is not confined to joint involvement in children but rather widespread effects extending to adulthood.  This study evaluated outcomes of patients with JIA compared to matched controls.

Methods: Population based cohorts of all residents of a geographically defined area who first met ILAR criteria for JIA in 1994-2013 and age- and sex-matched non-JIA comparator subjects were identified.  Outcomes during childhood utilized all patients and outcomes during adulthood were evaluated in 38 pairs, with follow-up beyond age 18. Employment and educational status based on patient report were obtained via medical record review.  Occurrences of hospitalizations and surgeries (both joint and non-joint related) were abstracted.  Pregnancies and comorbidities including depression and malignancy based on physician diagnosis were collected and evaluated.

Hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, and calendar year of incidence/index date were obtained from Cox models to evaluate differences in first occurrence of joint surgery, non-joint surgery, and hospitalization.  Poisson methods were used to obtain rate ratios (RR) with 95% CI to compare rates of outcomes.

Results: Eighty-nine patients with JIA were identified with 89 non-JIA comparators. Each group had 57 (64%) females.  The mean (standard deviation [SD]) age at diagnosis was 8.6 (5.1) years.  The length of follow-up after age 18 in patients with JIA 8.0 (5.5) years and non-JIA 8.9 (5.7) was similar. 

There was no difference in educational achievement; 25 (66%) versus 22 (58%) in patients with JIA versus not, respectively, had some education beyond high school (p=0.48).  Similarly, there was no difference in employment status with only 3 (8%) in each group who were unemployed or disabled (p=1.0).

It was more common for patients with JIA to have a joint surgery as compared to non-JIA both as children and adults, RR 3.93 (1.18, 24.94) and 8.50 (2.27, 120.1).  It is more likely for patients with JIA compared to non-JIA to have non-joint surgery as a child RR 1.90 (1.05, 3.67) and perhaps as adults, RR 1.92 (0.89, 4.57).  Similarly, hospitalization rates were higher during childhood, RR 2.25 (1.04, 5.53), and somewhat during adulthood, RR 1.79 (0.69, 5.25), when comparing patients with JIA versus non-JIA.

There was an increased risk of developing depression during childhood following JIA diagnosis/index date with HR 2.49 (1.01, 6.13).  However, in those who were not diagnosed with depression as children, there was no difference in depression during adulthood, HR 0.48 (0.10, 2.26).

No patients developed a malignancy over the course of follow-up. 

There was no difference in the rates of pregnancies between JIA and non-JIA women, RR 0.68 (0.38, 1.20).

Conclusion: In a modern population based cohort of patients with JIA compared to non-JIA subjects, there were higher rates of joint surgery both as children and adults, non-joint surgery as children, and hospitalizations as children.  The risk of depression during childhood was higher in JIA than non-JIA.  There were no differences in educational or employment outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-population-based-study-of-outcomes-of-patients-with-juvenile-idiopathic-arthritis-jia-compared-to-non-jia-subjects/