CLINICAL COURSE OF JUVENILE IDIOPATHIC ARTHRITIS IN HLA-B27-POSITIVE PATIENTS IN ADULTHOOD
Authors: Dzhus M.B. , Mostbauer H.V. , Karasevska T.A. , Ivashkivsky O.I. 
Published: August 2019

Relevance. The existence of associations between histocompatibility antigens and JIA variants has been proved. There is no consensus that the JIAs associated with HLA-B27 antigen are transformed in adulthood into other diseases for which it is necessary to revise the diagnosis, according to the adult classification of rheumatic diseases. Is this one process that began in childhood and continues into adulthood, and whether these two processes that begin in childhood and adulthood have common signs and differences? There is few data about the hallmarks of the disease and outcome in adulthood.  

Objective. – To investigate the frequency of HLA-B27 detection in adult patients with a history of JIA and to evaluate the clinical features of the course of arthritis in adulthood and the long-term articular and extra-articular consequences of JIA.

Materials and methods. A survey of 132 young adult patients with different variants of JIA in the history (70 women, 62 males), aged – 24,3±8,3 years; disease duration – 13,6±9,3 years. We evaluated body mass index, anamnestic data, visual analogue scale, C-reactive protein quantitatively, HLA-B27, rheumatoid factor (RF), IgG-antibody to cyclic citrulline peptide (anti-CCP) and antinuclear antibody (АNА). Long-term effects JIA assessed by joint indices (JADI-A) and extraarticular (JADI-E) damage. Disease activity in childhood and adulthood was assessed on a scale JADAS (Juvenile Arthritis Disease Activity Score) and DAS 28. For statistic analises we use the Statistica 6.0 software packages Copyright © StatSoft, Inc. 1984-2001.

Results. HLA-B27 was found in 38 patients with JIA (28,8 %), including 95 % of patients with enthesitis-related arthritis, 28,1 % – with persistent oligooarthritis and 36,8 % of patients with extended oligoarthritis, 8,3 % – with RF-positive JIA and 10,5 % – with the systemic onset JIA. According adult classification 61,5 % of patients with positive HLA-B27 antigen in adulthood developed ankylosing spondilitis or undifferentiated spondiloarthritis, in 22,7 % – undifferentiated arthritis, 100 % – psoriatic arthritis and 31,8 % – remission of the disease. In the childhood in HLA-B27 (+) patients, symmetrical joint damage (20,5 %, p<0,0001), enthesitis (20,5 %, p<0,05), lesion of the joints of the hands (26,4 %, p<0,05), defeat of more than 3 peripheral joints (36,8 %, p <0,05) and longer morning stiffness (Ме 40 [20; 60] min, p<0,001) were observed more often, compared with adult age. In adulthood, pain in the spine was significantly more frequent (27,5 %, p<0,01), as well as sacroilitis (15,0 %, p<0,05) and oligoarthritis (45 %, p<0,01). Only 21 % HLA-B27-positive patients received NSAIDs, 26,3 % had one DMARD and NSAIDs, 31,6 % had more than one DMARDs, and 21,1 % had a combination of different DMARDs and biological therapy (BTs). In childhood 58,3 % of patients received glucocorticoids and in adulthood only 22,2 % of patients but this difference was not significant. 42,1 % of adults needed intensification of therapy, 26,3 % of patients required BT. The most significant joint damages (JADI-A) in adulthood were found in the anti-CCP/RF-positive patients (3,04±4,90), whereas HLA-B27- positive patients had the lowest rates of this index, that shows the development of less remote negative consequences. Extra-articular damages (JADI-E) were most pronounced in АNА-positive patients (1,31±1,49), compared with a more favorable course in the groups anti-CCP/RF- (0,38±0,70; p <0,05) and HLA-B27-positive (0,50±1,06; p <0,05) patients.

Conclusion. Clinical manifestations of articular syndrome have certain age-related pecularities in HLA-B27-positive patients with JIA: symmetrical joint damage, enthesitis, lesion of the joints of the hands, affections of more than 3 peripheral joints, and more prolonged morning stiffness are observed in childhood but in adulthood, pain in the spine, sacroilitis and oligoarticular lesion are more common. The presence of HLA-B27 antigen in patients with JIA is associated with the development of a smaller number of long-range articular damage (JADI-A), compared to the anti-CCP/RF-positive group (p <0,05) and less of the remote extra-articular effects (JADI- E) compared with the group of ANA-positive patients (p <0,05) in an adulthood.