We report a 6-yr follow-up study of an original population of 50 patients who had three or more major joints (hips and knees) replaced. Thirty-one of 32 surviving patients were still ambulant in the community, and all patients described significant pain relief. No RA patient was requiring permanent inpatient or residential care and the family remained the main social support. They remained a very disabled group with a median Health Assessment Questionnaire score of 2.75. Ten required revision surgery: three hips and seven knees; four patients required their fourth lower limb joint (hip/knee) replaced and seven patients required surgery to the upper limbs and nine feet during the follow-up period. The median 10-yr survival of hip and knee arthroplasties in multiple joint replacement (MJR) patients with RA was 90.5 and 78.6% respectively. There was an increased incidence of cervical myelopathy in MJR patients 16.9%. The mortality rate was higher than expected (standardized mortality ratio = 590) but the actual surgery was not implicated. MJR therefore appears to be a worthwhile policy, even at long-term follow-up.

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BackgroundInformation regarding longer-term outcomes in JIA largely pre-date the introduction of biologic therapies and have been cross-sectional.ObjectivesThe aim of this study was to assess outcomes over the first 5 years of disease in children diagnosed with oligoarticular and polyarticular JIA since 2001.MethodsChildren with oligoarthritis, rheumatoid-factor (RF) negative or positive polyarthritis were selected if recruited to the Childhood Arthritis Prospective Study (CAPS), a UK multicentre inception cohort, between October 2001 and January 2011. The following outcomes were assessed annually to five years and included in this analysis: functional ability (Childhood Health Assessment Questionnaire (CHAQ)), the absence of limited joints, overall psychosocial health (psychosocial scale on the Child Health Questionnaire (CHQ)) and the proportion of children with CHQ psychosocial scores two standard deviations below the population mean (CHQ psychosocial<30).Outcomes were assessed descriptively over time and differences between subtypes were assessed by applying multilevel (patient-level) zero-inflated negative binomial (CHAQ), logistic (absence of limited joints, percent CHQ psychosocial<30) and linear (CHQ psychosocial) regression analyses, adjusting for gender, age at presentation and hospital.ResultsOf 832 children, 70% were female, 68% had oligoarticular, 28% RF-negative and 5% RF-positive polyarticular JIA. Eighty four percent had ever been treated with NSAIDs, 74% corticosteroids, 55% with DMARDs and 21% with biologics within follow-up.Baseline CHAQ was good to moderate (median 0.8, IQR 0.1 to 1.4) and only 21% of children had no limited joints reported at this time. CHQ psychosocial scores (median 50, IQR 39 to 55) were moderate, with 11% children scoring at least two standard deviations under the population mean. Overall improvements were evident in all outcomes over the first year then remained stable with no further improvements at the cohort level evident to five years.Patients with RF-negative polyarthritis experienced significantly poorer outcomes across all variables than those with oligoarthritis. Those with RF-positive polyarthritis recorded similar CHAQ scores to patients with RF-negative polyarthritis but had the lowest odds of no limited joints (OR: 0.4, 95% CI 0.3 to 0.7) and the poorest CHQ psychosocial scores (4.8 points worse and 4.7 times the odds of scores <2 standard deviations of population mean), compared with those with oligoarthritis.ConclusionsOn average, the largest improvement in functional ability, limited joints and psychosocial health occur in the first year following diagnosis, perhaps confirming the importance of early treat-to-target strategies. Patients with polyarticular JIA subtype have poorer parent and physician-reported outcomes than those with oligoarthritis.Disclosure of InterestNone declared

BackgroundIdentifying predictors for early clinically inactive disease (CID) would allow stratified treatment decisions at diagnosis, minimising the burden of unnecessary therapies. JIA core outcome variables (COVs) are routinely collected and would therefore be convenient predictors. However, different groups of children are identified by current CID definitions (Wallace's preliminary criteria vs. clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10)) and predictors may differ depending on which CID outcome is applied.ObjectivesTo assess whether baseline COVs predict achievement of CID according to Wallace's preliminary criteria or the cJADAS10 cut-off in patients with JIA.MethodsChildren and young people enrolled to the Childhood Arthritis Prospective Study (CAPS), a UK multicentre inception cohort, before January 2011, were selected if diagnosed with oligoarticular, RF-negative or RF-positive polyarticular JIA.At one year following initial presentation to paediatric rheumatology, children were classified as i) CID according to Wallace's preliminary criteria and ii) CID according to cJADAS10. Baseline COVs (active joint count, limited joint count, physician's global, parental global, functional ability (Childhood Health Assessment Questionnaire (CHAQ)) and ESR) were tested for predictive ability for these outcomes using univariate and forced-entry multivariate logistic regressions, adjusting for age and symptom duration at initial presentation, gender and ILAR subtype. Multiple imputation accounted for missing data.ResultsOf 829 children included, 70% were female and the majority had oligoarticular JIA (68%). At one year, 28% had achieved CID according to Wallace's preliminary criteria and 38% according to the cJADAS10 (21% CID on both).In univariate analyses, increased baseline CHAQ and physician's global assessment score predicted lower odds of achieving both CID states. In addition, increased active joints (OR: 0.97, 95% CI0.94, 0.99), and patient/parent global assessment scores (OR: 0.87, 95% CI 0.81, 0.93) predicted lower odds of CID on the cJADAS10 only. In multivariate analyses, one increased CHAQ point at baseline independently predicted 28% lower odds of CID on the cJADAS10 (95% CI 0.53, 0.98). However, no baseline COVs predicted CID on Wallace's preliminary criteria. No demographic variables were significantly predictive in any model.ConclusionsThere were different predictors for CID on the cJADAS10 vs. Wallace's preliminary criteria. Children with poor functional ability at initial presentation are less likely to achieve CID on the cJADAS10. These children could be targeted with more aggressive treatment strategies to better control their disease.Disclosure of InterestNone declared