Background/Purpose: Juvenile arthritis (JA) is the most common pediatric rheumatic disease, with potentially permanent functional impacts on patients long after initial diagnosis. Little is known about adulthood outcomes. This systematic review aims to summarize clinical outcomes in adults with JA (age >16), identify gaps of knowledge and recommend future research directions.

Methods: MEDLINE and EMBASE searches were developed and conducted with an academic librarian. We focused on studies 2000-2017 for contemporary management outcomes. We excluded: non-English publications, studies evaluating the transition process, qualitative studies, obstetric outcomes, short reports/letters, case series. Mixed population studies were included if the mean/median age at assessment was >16 years. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk-of-bias in 6 study domains: population, attrition, outcomes, prognostic factors, confounding, statistics. Each publication was assessed by 2 reviewers. Study data were extracted using a standard form.

Results: 56 of 12 243 papers were included in this study for analysis. The majority (52%) of studies were retrospective cohorts, and the most common study queries were disease (34.9%), functional status/psychosocial (22.2%), temporomandibular joint (11.1%), and uveitis (9.5%) outcomes. 13 publications (21%) were repeat publications of non- unique cohorts, with the majority of these using the same cohort from Norway. Moderate-high risks of bias were present especially in study confounding (95%), participation (81%) and attrition (82.1%) domains.

In disease outcomes, the most common reported were remission (36%), and use of DMARDs (71%). HAQ functional status was reported with a median score of 0.49, signifying mild disability. VAS pain scale had a median score of 6.51 cm. DMARDs and NSAIDs usage ever were reported with 42.8% and 63.3% respectively. Uveitis was reported in 22.9% patients. Out of 56 papers, 35 performed statistical multivariable modelling. Within each study topic there were no multivariable models of similar outcomes to allow for identification of consistent prognostic factors.

Conclusion: Only 2 (3.1%) truly longitudinal studies focused on the adult outcomes of JA patients. Although there have been many studies published on outcomes in JA adults, they have moderate-high risks of bias in crucial study domains that limited interpretation of results. Prognostic factors were non-reproducible and could not be summarized. Attention to selection of study population and accounting for attrition and confounding will improve quality of future studies. There should be a discussion among investigators to establish reporting of core outcomes in future adult JA studies to allow comparisons and facilitate future meta-analysis. In future studies we aim to categorize outcomes by duration of disease and start formulating a potential standard reporting format for future JIA research.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-outcomes-of-juvenile-arthritis-in-adulthood-a-systematic-review/