СLINICAL AND LABORATORY DATA AND ALGORITHM OF MANAGEMENT OF ADULT PATIENTS WITH POLYARTICULAR VARIANT OF JUVENILE IDIOPATHIC ARTHRITIS
Authors: Dzhus M.B. , Mostbauer G.V. , Karasevska T.A. , Shevchuk M.I. , Kulik M.S. 
Published: January 2020

Relevance. The polyarticular variant of juvenile idiopathic arthritis (JIA) is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses. At 18, patients go under the supervision of adult rheumatologists, often accompanied by loss of control of the disease due to insufficient compliance from both the patient and the physician. Today, there is no documented process for the transfer of patients from childhood to adulthood in Ukraine. Therefore, creating an algorithm for managing such patients is an urgent task.The polyarticular variant of JIA is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses.

 Objective of this study was to evaluate the clinical and laboratory status and to develop an algorithm for managing adult patients with polyarticular variant of JIA, depending on the detection of RF or/and A-CCP.

 Materials and methods. The study included 168 adult patients from different regions of Ukraine who were diagnosed with JIA in childhood between 1984 and 2014 without severe comorbidities.  Inclusion criteria were: 16 to 60 years old;  duration of the disease more than 3 years;  the presence of documentary evidence of childhood diagnosis of JIA (ambulatory card, hospital records). Among patients with JIA were identified 53 patients with polyarticular variant, of whom 42 or 25% - with RF (-) polyarthritis and 11 or 6.5% - with RF (+) polyarthritis. The disease activity was evaluated by DAS28 and JADAS-10. The questionaries SF-36, HAQ, TAS-20, PHQ-9 were analyzed and remote articular JADI-A and extra-articular JADI-E damages were evaluated. Statistical studies were performed using IBM SPPS Statistics version 25.0.0.0 software, the results were considered to be reliable at 5% critical level (P <0.05). 

Results. The negative correlation of JADI-A and the patient's physical well-being PCS (r = -0.27, p <0.05) and physical functioning (r = -0.24, p <  0.05), pain intensity (r = -0.24, p <0.05), general health (r = -0.24, p <0.05), vital activity (r = -0,  19, p <0,05), social functioning (r = -0,27, p <0,05), mental health (r = -0,22, p <0,05) according to SF-36. The severity of extra-articular damages JADI-E correlated with PCS (r = -0.22, p <0.05) and physical functioning (r = -0.28, g  <0.05), pain intensity (r = -0.20, p <0.05), general health (r = -0.23, p <0.05), and mental health (r =  -0.23, p <0.05), but also had a positive rcorrelation with HAM-A (r = 0.25, p <0.05), depression scale (r = 0.28, p <0,  05) and PHQ-9 (r = 0.28, p <0.05).  Significantly lower level of physical health was established in patients who requires prosthetics (p <0.001) compared to those who did not need prosthetics. 

Conclusion. Based on the results obtained, algorithms for managing adult patients with JIA positive for RF or / and A-CCP were developed, depending on the detected articular and extra-articular damages and the need for prosthetics and the psychological status.