Evaluation of disease activity in a low-income juvenile idiopathic arthritis cohort

Abstract

Determine disease activity in a low income juvenile idiopathic arthritis (JIA) cohort. 164 JIA patients from families with less than US$ 4500.00/capita mean annual income followed in Fortaleza-CE, Brazil, were cross-sectionally evaluated between May 2015-April 2016. Mean age was 14 ± 5.1 years (95 female) with 10.31 ± 3.7 years disease duration. Polyarticular category predominated, with 63 (38.4%) patients, followed by 40 (24%) enthesitis-related (ERA), and 36 (22%) oligoarticular. All but 1 out of 84 parents declared less than US$ 10,000.00 annual family income. Eighty-eight (60.7%) were receiving methotrexate and 19 (13%) leflunomide including 12 (63%) using both; 46 (28%) were on biologic DMARD including 20 (43.5%) adalimumab, 17 (41.5) etanercept, 5 (10.8%) tocilizumab, 2 (4.2%) abatacept, and 1 (2.1%) each on infliximab and canakinumab. Mean CHAQ and JADAS27 were 0.36 ± 0.55 and 5.31 ± 8.5, respectively. Thirty-two (20%) out of 159 patients had deformities. A bivariate analysis revealed that polyarticular had more deformities than oligoarticular patients (p = 0.002; OR = 2.389; 95% CI 1.37-4.14). Logistic regression showed no association between high JADAS and family income (p = 0.339; OR = 1.45; 95% CI 0.67-3.31). A general linear model showed significantly lower CHAQ score in patients from families earning more as compared to those earning less than 300.00 US$ monthly (p = 0.002). This study reports JIA disease activity in a low income population. Low income apparently did not influence prognosis given the low mean JADAS27 and CHAQ scores vis-à-vis data from other cohorts.

Cumulative Social Disadvantage Associated with Childhood Arthritis: ACross‐SectionalAnalysis of the National Survey of Children's Health

“…Small retrospective studies in adult inflammatory arthritis and JIA have demonstrated that lower income level and lower guardian education level may be associated with higher disease activity, though these relationships were no longer significant after 1 year of follow-up (4,5). Similarly, family income level was not associated with significantly higher measures of disease activity in a recent cross-sectional analysis of Brazilian patients (6). The concept of social adversity impacting childhood arthritis was highlighted by a recent analysis, which demonstrated that increased exposure to adverse childhood experiences (ACEs) yielded higher odds of an arthritis diagnosis (7).…”

“…We generated a cumulative social disadvantage score (range 0–4) by giving 1 point for each of the following domains: highest education obtained by household respondent is high school or less, household income level is 0–199% of the federal poverty level (FPL) (a level closely associated with Child Health Insurance Program qualification in most US states [10]), child insurance status is public or uninsured, and high ACE score (≥4 of the following ACEs: financial insecurity, guardian divorce, guardian death, guardian in jail, exposure to domestic violence, exposure to neighborhood violence, mental illness in household, substance use in household, or experiencing racism). These 4 social domains were chosen, as they have been previously investigated as risk factors in childhood arthritis outcomes (2–7). We did not perform imputation because of the low rate of missingness of key demographic and social variables.…”

Microbes, helminths, and rheumatic diseases

“…Indeed, it is surprising that the CHAQ scores were lower than those collected among JIA patients evaluated in the Pediatric Rheumatology International Trials Organization (PRINTO) and Childhood Arthritis and Rheumatology Research Alliance (CARRA) registries that gather data from high-income populations, with presumably better sanitation and oral hygiene. Although it may just be coincidental, there is a high prevalence of helminthiasis in our low-income population leading us to speculate whether helminths or their products downmodulate inflammation in autoimmune diseases, thus decreasing severity [39] (Fig. 1).…”

Índices e fatores relacionados à adesão ao tratamento farmacológico em pacientes com Artrite Idiopática Juvenil

“…O metotrexate (MTX) é eficaz, relativamente seguro e de baixo custo. Também é o fármaco de primeira escolha no tratamento da AIJ, embora não esteja descrito nos guidelines para o tratamento da AIJ no Brasil (Angeles-Han et al, 2019;Pelajo et al, 2012, Rocha et al, 2019. O uso do MTX se deve a sua capacidade de associação com outras drogas modificadoras de doença reumática (DMARDs) clássicas e/ou biológicas ou substituído por imunobiológico diante de intolerância ou não responsividade (Gianane et al, 2019).…”

“…O uso do MTX se deve a sua capacidade de associação com outras drogas modificadoras de doença reumática (DMARDs) clássicas e/ou biológicas ou substituído por imunobiológico diante de intolerância ou não responsividade (Gianane et al, 2019). Portanto, a adesão ao tratamento é imprescindível para o sucesso terapêutico que envolve remissão ou baixa atividade da doença (Rocha et al, 2019). Por outro lado, a não adesão ao tratamento pode levar ao comprometimento da saúde do paciente por causar do aumento da atividade da doença, deformidade e incapacidade física, bem como aumento das consultas, diagnósticos e tratamentos adicionais (Cutler et al, 2018, Pasma et al, 2015Marshall et al, 2019;Cardoso et al, 2021), além de aumentar os custos com o deslocamento do paciente a unidade de saúde e a morbidade.…”