Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
In the recent years the classification of Juvenile Idiopathic Arthritis (JIA) according to the ILAR criteria has been questioned as some categories still include heterogeneous conditions. One of the questions posed is if patients with a positive Antinuclear Antibody (ANA) should be a separate category. Previous studies have shown contradicting evidence to support the separation of patients based on ANA status.
The aim of this study was to evaluate disease outcome defined as remission based on ANA status. Secondary aims of the study included the clinical and disease activity features of ANA positive patients in comparison to the ANA negative patients at disease onset and last follow-up.
Methods: A retrospective cohort study; all patients diagnosed with JIA according to the revised ILAR criteria attending our Pediatric Rheumatology Center from January 2000 until May 2014 were included.
A minimum follow-up of 1 year was required. ANA positivity was defined as at least 2 positive results with a titer ≥ 1:160. ANA was measured by indirect immunofluorescence assays on HEp-2 cells. Demographic and clinical features were collected. Remission at last follow-up was defined by Wallace criteria for remission on (>6 months) and off (>12 months) medication. Descriptive analysis (Chi-square) was performed (SPSS).
Results:
A total of 625 patients met the inclusion criteria. Of these patients 229 (37%) were ANA positive. ANA positivity was correlated to a female predominance and young age at diagnosis (p<0.05). Joint count at diagnosis and at last follow-up showed no difference between both groups. At least half of the patients in both groups were treated with MTX. Treatment with TNF alpha blocking agents was seen more frequently in patients with a positive ANA.
Nine % of the total patient cohort had uveitis and 50% of these patients were treated with anti-TNF-alpha.
Disease outcome; remission on or off medication, showed no differences between both groups and it was irrespective of uveitis. Sub-analysing the ANA positive oligoarticular-persistent, extended and polyarticular RF-neg patients (n=200) showed a significant difference for remission on and off medication; oligoarticular-persistent patients more frequently were in remission off medication, while oligoarticular-extended and polyarticular RF-neg were more frequent in remission on medication. The latter groups also received more MTX and anti-TNF alpha treatment.
|
|
ANA negative |
ANA positive |
|
JIA |
396 (63%) |
229 (37%) |
|
Systemic JIA |
48 (92%) |
4 (8%) |
|
Oligoarticular persistent |
122 (57%) |
93 (43%) |
|
Oligoarticular extended |
51 (50%) |
50 (50%) |
|
Polyarticular RF-neg |
68 (54%) |
57 (46%) |
|
Polyarticular RF-pos |
13 (62%) |
8 (38%) |
|
Psoriatic JIA |
34 (83%) |
7 (17%) |
|
ERA |
31 (82%) |
7 (18%) |
|
Undifferentiated JIA |
29 (94%) |
3 (6%) |
|
|
|
|
|
Gender* |
226 male, 169 female |
50 male, 179 female |
|
Age at diagnosis* (years) |
9.2 |
6.4 |
|
Disease duration* (years) |
5 |
6.4 |
|
Uveitis* |
13(3%) |
42 (18%) |
|
Joint count at diagnosis |
2.9 |
3.1 |
|
Methotrexate treatment |
203 (51%) |
134 (59%) |
|
Anti-TNF alpha treatment* |
86 (22%) |
71 (31%) |
|
Last follow-up |
||
|
Joint count last follow-up |
< 0.1 |
< 0.1 |
|
Remission on medication < 6months |
26 (7%) |
13 (6%) |
|
Remission on medication > 6 months |
99 (25%) |
61 (27%) |
|
Remission of medication < 12 months |
33 (8%) |
19 (8%) |
|
Remission of medication > 12 months |
219 (55%) |
115 (50%) |
|
Active disease |
22 (1%) |
21 (9%) |
*Statistically significant (P<0.05)
Conclusion:
Our findings show that ANA positive patients do not differ from ANA negative patients when comparing remission rate. This was independent of uveitis. However in the ANA positive group a different remission rate and medication use is seen for the different subtypes. Although ANA positive oligoarticular-extended and polyarticular RF-neg patients reach remission on medication, oligoarticular-persistent patients have a higher remission rate off medication.
To cite this abstract in AMA style:
Glerup M, Herlin T, Twilt M. Does Antinuclear Antibodies Predict Remission in JIA ? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/does-antinuclear-antibodies-predict-remission-in-jia/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-antinuclear-antibodies-predict-remission-in-jia/