DYNAMIC MONITORING OF ADULT PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Abstract

During the last years, significant progress has been made in the treatment of juvenile idiopathic arthritis (JIA), although the availability of modern treatment is limited for Ukrainian patients due to high costs and lack of adequate government support.

The aim of the work – to conduct an examination of young adult patients with JIA at the time of referral to an adult rheumatologist and one year follow-up with an assessment of the dynamics of clinical signs, laboratory data, psychological state, bone mineral density (BMD) and treatment.

Materials and Methods: The study included 168 patients with JIA, > 18 years old. All patients were examined on the basis of Oleksandrivska Town Clinical Hospital, Kyiv, Ukraine. Clinical and laboratory data of disease activity, quality of life (QoL) by SF36, alexethymia by TAS-10, level of depression of PHQ-9, bone mineral density and treatment were evaluated.

Results. During the 1 year follow-up of adult patients with JIA on the basis of the treatment according to the unified clinical protocol of medical care, the patients with JIR showed a decrease in the duration of morning stiffness (p <0.05), improvement of articular syndrome, reduction of arthritis of the hands (p < 0.05), arthritis of >3 joints (p <0.05), symmetrical arthritis (p <0.05), enthezites (p <0.05), spinal pain (p <0.05), that reflected in a decrease (p <0,05) of the degree of functional dissability of the joints and the absence of X-rays progression. Although no dynamic changes of systemic manifestations, uveitis and sacroilitis were detected. There was no positive dynamics of DAS28 and JADAS, ESR, CRP. Patients with JIA have active disease after 1 year of observation in adulthood. An increase in the vitamin D 25- (OH) level (p <0.05) was detected in one year of follow-up, although it was still not normalized. It was established that both at the time of the primary examination and after 1 year follow-up the BMD in different parts of the skeleton, the Z- and T-score were reliably lower than in the control group. However, when evaluating the BMDs in different parts of the skeleton, Z- and T-score no dynamic changes were observed during the year of observation. After 1 year follow-up no differences were detected either on QoL and its scales, nor on the level of alexethymia, nor on the degree of depression. Although 45 % of patients with JIA after 1 year of follow-up in adulthood had a mild "subclinical" to moderate severity of depression, while at the time of primary examination by adult rheumatologist, 61.1% of patients experienced varying degrees of depression.

Conclusions. Patients with JIA durring transition period after 1 year follow-up showed stabilization of both clinical and psychological states. After 1 year of observation, a decrease in the duration of morning stiffness and improvement of articular syndrome was revealed, that is reflected in a decrease in the degree of functional dissability of the joints and the X-ray progression, although laboratory activity is maintained high. During the evaluation of the BMDs in different parts of the skeleton, Z- and T-scores, no positive dynamic changes were observed during the year of observation. After 1 year follow-up of adult patients with JIA, no differences in QoL and its scales, alexethymia, and degree of depression were found, indicating the need for their correction with the participation of appropriate specialists. 32 (19 %) patients durring JIA course did not receive any disease-modifying drugs (DMDs), 53 (31.5 %) patients received 1 DMD durring JIA course, 34 (20.2 %) patients were received sequentially or concurrently 2 DMDs, 11 (6.5 %) patients received sequentially or concurrently 3 DMDs, 19 (11.3 %) patients received 1 DMD and 1 immunobiologic therapy (IBT), 10 (6 %) patients received 2 DMDs and 1 IBT, 9 (5.4 %) patients – more than 3 DMARDs or more and 2 IBT.