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Abstract Number: 406

Adults with Juvenile Idiopathic Arthritis Are Not Adults with Rheumatoid Arthritis

Rayford R. June1, Danielle Feger2, Nicholas Longson3, Barbara E. Ostrov4,5 and Nancy J. Olsen6, 1Rheumatology, Penn State Hershey Medical Center, Hershey, PA, 2Medicine/Rheumatology, Penn State College of Medicine, Hershey, PA, 3Johns Hopkins University, Baltimore, MD, 4Pediatrics, Penn State Hershey Medical Center, Hershey, PA, 5Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA, 6Medicine/Rheumatology, Penn State Hershey Medical Center, Hershey, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: classification criteria, juvenile idiopathic arthritis (JIA), polyarthritis and rheumatoid arthritis (RA)

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Session Information

Date: Sunday, November 13, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster I: Juvenile Idiopathic Arthritis, Uveitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Juvenile Idiopathic Arthritis (JIA) persisting into adulthood is associated with articular damage, increased disability and mortality. Approximately 100,000 polyarticular JIA patients will enter adult practices over the next 10-15 years and represent a distinct population for these providers. We initially searched the electronic medical record (EMR) for adult patients with JIA, but found that only physicians with pediatric training used the JIA diagnosis while the rheumatoid arthritis (RA) diagnosis was used by the adult rheumatologists. Considering differences in clinical features, we hypothesized that the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA criteria would have lower sensitivity than the 1987 RA criteria for classification of polyarticular JIA patients, compared to an adult-onset RA cohort.

Methods: Patients > 18 years of age with an established JIA diagnosis made ≤16 years who were seen by adult rheumatology between January 1st 2013-June 1st2015 were evaluated. EMR extraction with rheumatologist review was performed and disease features were recorded. A prospective observational cohort of RA was used for comparison. JIA was retrospectively classified using the International League of Associations for Rheumatology (ILAR) JIA classification criteria and RA was classified using the ACR/EULAR 2010 and the 1987 criteria. McNemar’s test, chi-square, and Welch’s t-test were used to test for group differences between polyarticular JIA and RA.

Results: 67 adult subjects had JIA, with 45 having polyarticular disease, were compared to 66 subjects with RA. Polyarticular JIA subjects had a mean age of 27 years, 89% were female, with mean disease duration of 20.6 years. 29% (9/31) were rheumatoid factor (RF) positive. While 71.1% (32/45) met the 1987 RA criteria, only 46.7% of polyarticular JIA subjects met the 2010 RA criteria (p<0.0001). RA subjects had a mean age of 56 years, were 78% female, with mean disease duration of 11.2 years. 74% (43/58) were RF positive. 81.8% (54/66) met the 1987 criteria whereas 87.9% met the 2010 RA criteria. Patients with RA were approximately 1.88 times (95% RR 1.36, 2.61) more likely to meet the 2010 ACR/EULAR RA criteria than those with polyarticular JIA.

Conclusion: Adults with polyarticular JIA have unique clinical characteristics from RA, highlighted by less than half meeting the 2010 ACR/EULAR RA classification criteria. Accurate classification is the first step to define optimal evaluation and treatment in this unique patient population. Rather than blurring the clinical picture, adult rheumatologists should have increased awareness of JIA disease subtype.

Demographics and Disease Characteristics: Polyarticular JIA vs. RA
Variable Poly JIA Mean ± SD or % (n) RA Mean ± SD or % p-value
Sample Size 45 66
Current Age 27.37 ± 9.26 56.04 ± 13.60 <0.0001*
% Female 88.89% (40/45) 78.79% (52/66) 0.1654
Disease Duration 20.61 ± 10.60 11.19 ± 10.34 <0.0001*
HAQ 0.4281 ± 0.5800 (N = 40) 0.3179 ± 0.3985
RF+ 29.03% (9/31) 74.14% (43/58) <0.0001*
CCP+ 28.57% (2/7) 68.52% (37/54) 0.0870
ANA ≥ 1:40 58.06% (18/31) 38.46% (20/52) 0.0829
% Current MTX 24.44% (11/45) 37.88% (22/66) 0.2390
% Past MTX 68.89% (31/45) 43.94% (29/66) 0.0288*
% HTN 4.44% (2/45) 37.88% (25/66) <0.0001*
% Meeting 1987 71.11% (32/45) 81.82% (54/66) 0.1849
% Meeting 2010 46.67% (21/45) 87.88% (58/66) <0.0001*

Disclosure: R. R. June, None; D. Feger, None; N. Longson, None; B. E. Ostrov, None; N. J. Olsen, None.

To cite this abstract in AMA style:

June RR, Feger D, Longson N, Ostrov BE, Olsen NJ. Adults with Juvenile Idiopathic Arthritis Are Not Adults with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/adults-with-juvenile-idiopathic-arthritis-are-not-adults-with-rheumatoid-arthritis/. Accessed .
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