Radiographic damage in hands and wrists of patients with juvenile idiopathic arthritis after 29 years of disease duration

Abstract

BackgroundThere are few studies on radiographic outcome after long-term disease duration in juvenile idiopathic arthritis (JIA). We wanted to evaluate 29-year radiographic outcome in hands/wrists and predictors of damage in patients with long-term active JIA.MethodsPatients diagnosed from 1980 to 1985, who had active disease at 15-, 23- or 29-year follow-up and arthritis in the wrists during the disease course, were reexamined with radiographs of hands/wrists. We used the adapted version of the Sharp van der Heijde (aSvdH) score and Carpal Height Ratio (CHR) to evaluate radiographic outcome.ResultsSixty patients, mean age 38 years, were reexamined at median 29-year follow-up. 33 patients (55%) had an aSvdH score >0, median score was 4.0 (range 0–313), and 25% of the scores were high (≥53). Most patients with radiographic damage (88%) had both erosions and JSN. 52% of the patients had damage in the wrists, 43% in the MCP joints and 40% in the PIP joints.The CHR correlated strongly with the aSvdH. Both scores had high correlations with the Juvenile Arthritis Damage Index and the number of joints with limited range of motion (LROM) (rs = -0.688 to 0.743, p ≤ 0.001). The aSvdH correlated weakly with measures of disease activity.The number of joints with LROM, ESR and the HAQ disability score at 15 years and HLAB27 positivity predicted the aSvdH score and the CHR at 29-year follow-up.ConclusionsThe majority of patients with long-term active JIA had modest radiographic damage, but more frequently in wrists than in fingers. The radiographic scores correlated well with measures of disease damage. Restricted mobility in joints at 15 years was the most important predictor of radiographic damage at 29 years.

B Cells on the Stage of Inflammation in Juvenile Idiopathic Arthritis: Leading or Supporting Actors in Disease Pathogenesis?

“…In fact, it has been demonstrated that ACPA detected in pJIA RF+ patients express the inherently autoreactive 9G4 idiotope, which supports an activation of autoreactive 9G4+ B cells in JIA ( 148 ), similarly to what has been described in RA patients ( 149 ). Importantly, ACPA detection in JIA patients is associated to more severe and erosive disease progression, which might implicate an earlier and more intensive treatment ( 8 , 112 – 114 , 146 , 150 , 151 ). During inflammation, ACPA might be produced in a process called citrullination, a post-translational modification catalyzed by peptidylarginine deiminases (PAD) enzymes in which arginine amino acid residues are enzymatically converted into citrulline residues in a wide range of proteins ( 152 , 153 ).…”

Juvenile idiopathic arthritis patients have a distinct cartilage and bone biomarker profile that differs from healthy and knee-injured children

“…Current methods to monitor destructive events are clinical evaluation in combination with radiographic imaging that identifies changes in the joint structure and joint space caused by loss of articular cartilage and bone. However, these methods are insensitive and mainly detect late stages of destruction (7,8). Joint destruction often progresses from the cartilage surface to the subchondral bone and leads to structural degradation and release of molecular fragments of the joint into biologic fluids, which could be used as biomarkers (9).…”

Dynamics of Destructive Joint Changes in Juvenile Idiopathic Arthritis in Children who Received Methotrexate or Methotrexate-Tocilizumab Combination: a Cohort Study

“…Это первый препарат на российском рынке, который воздействует на механизм заболевания в его ключевом звене и при-останавливает его дальнейшее развитие. Результаты нескольких международных рандомизированных пла-цебоконтролируемых исследований показали высокую эффективность препарата для лечения как системных проявлений болезни, так и уменьшения степени деструк-ции суставов, а также хороший профиль безопасности препарата [21][22][23].…”

“…Обычное рентгенологическое исследование остается «золотым стандартом» для выявления структурного пора-жения суставов и нарушения костей у пациентов с ЮИА [23]. Для оценки рентгенологического прогрессирова-ния суставной деструкции часто используют модифи-цированный метод Шарпа (Sharp/van der Heijde), реко-мендованный Европейской антиревматической лигой (EULAR).…”