Background/Purpose: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that often persists into adulthood. In addition to disability and poorer quality of life, JIA is associated with increased long-term morbidity and mortality. The long-term risk of comorbidities is uncertain and guidance on risk assessment is not currently available. The objective of this study was to determine the frequency of comorbid conditions in JIA patients.

Methods: Patients with JIA transferred from the biologic registry BIKER to the follow-up (FU) registry JuMBO were included in this analysis. All comorbidities, except for serious infections, prospectively recorded by physicians to BiKeR or JuMBO were considered. Comorbidity rates among the various JIA categories were assessed. The Medical Dictionary for Regulatory Activities (MedDRA) was used for disorder coding. Differences in the occurrence of comorbidities between JIA categories were analyzed by multinomial logistic regression.

Results: A total of 1,022 young adults (67% female) with JIA and a mean FU of 7.8 (SD=3.5) years (ys) were included in this analysis. The patients´ mean age was 23.1 ys (SD=3.7), and disease duration was 12.8 ys (SD=5.9) at last FU. The majority were classified as polyarticular-course JIA (53%) at BiKeR enrollment. Patients had received a mean of 2.9 (SD=1.3) DMARDs, 77% were ever treated with biologics. Comorbidities were reported for more than half of the patients (54%), 24.5% of the conditions were stated for the first time in adult age. Eye disorders were the most common comorbid condition group (16.9%), followed by Immune system disorders (12.3%), and psychiatric disorders (10.1%). The most frequently reported single diseases were uveitis in 15.9%, depression in 9.1%, hypertension in 8.5%, chronic secondary pain syndrome in 4.4%, and psoriasis in 3.3%. Females had significantly more often depression (11.8% versus 3.4%), pain syndromes (5.8% versus 1.6%), and autoimmune thyroiditis (3.3% vs. 0.9%) than males, whereas men had more often inflammatory bowel diseases than women (4.0% vs. 1.9%)). The rate of comorbid conditions significantly differed across the various JIA categories, with the highest rates in patients with extended oligoarthritis, psoriatic arthritis and systemic arthritis. While extraarticular manifestations of JIA were the most common comorbid conditions in extended oligoarthritis and psoriatic arthritis, disease- or treatment-related complications were relevant comorbidities in systemic arthritis.

Conclusion: Young adults with JIA have a high rate of comorbidity overall, with extraarticular JIA manifestations being the most frequent comorbid conditions. Comorbidity rates vary among the various JIA categories. Patients with systemic JIA have the highest rate of cardiovascular risk factors and osteoporosis, while patients with extended OA have the highest rate of uveitis. An underreporting or unawareness of comorbidities by rheumatologists is possible, guidance on risk assessment in adults with JIA is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequency-of-comorbidities-in-patients-with-juvenile-ideopathic-arthritis-results-of-an-observational-cohort-study/