FRI0351 Outcome of 267 JIA patients from a tertiary level indian pediatric rheumatology centre
Authors: M. Agarwal, M. Jariwala, S. Sawhney, V. Dinand
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> We run a pediatric rheumatology service at a tertiary level hospital. We follow a policy of “treat to target”.We systematically studied the JIA patients who followed up in the unit from 2009 September to 2012 January. <h3>Objectives</h3> 1. To study the clinical profile of patients with JIA. 2. To evaluate the disease outcome at follow up using the Wallace criteria into:active disease (AD), inactive disease (ID), clinical remission on medication (CRM) and clinical remission off medication (CROM) (1). 3. To correlate factors that may impact outcome. <h3>Methods</h3> JIA patients who had completed≥6 months of followup were included. All data, including the core set (2), were collected on standardised proformas. <h3>Results</h3> <i>Demographics:</i> Of 267 patients, 59% were boys. JIA subcategories: ERA37.8%,SJIA 22.8%, OJIA 13.8%, polyarticular 12.7%, seropositive polyarticular7.8%,unclassifiable 3.8% and PsJIA (psoriatic JIA) 1.1%. Median age at disease onset for the cohort was 8 yrs range 0.58-16) and median age at diagnosis was 9.5yrs (range 0.66-21). Median delay to diagnosis was 12.65 months (range 0.2-144) and median duration of follow up was 25 months (range 6-108) <i>Outcome:</i> 31.86% had inactive disease, 27.7% were in CRM and 6.7% patients were in CROM at median follow up of 25 months. 33.7% patients had AD. Subcategories: 78.4% of OJIA,70% of UJIA, 69%SJIA, 66% ERA, 62% PJIA, 43% seropositive JIA and 33% of PsJIA had no disease activity (all states of ID, CRM, CROM) <i>Factors affecting outcome:</i> Number of active joints at onset: Patients with AD had a median of 4 active joints at onset v/s patients with ID who had a median of 3 active joints (p=0.007). Delay to diagnosis: Patients with AD at outcome had a median delay to diagnosis of 6 months v/s patients with ID who had a median delay of 4 months (p=0.002). <i>CHAQ:</i> 76% patients had no disability,17% mild, 5% moderate whereas 3% had severe disability (3). <i>Management:</i> Patients were managed with NSAIDs, bridging steroids, IAS and DMARDs as appropriate. Only 24% had received BRMs. <h3>Conclusions</h3> 66% of patients with JIA had no discernable disease activity at a median follow up of two years,comparable to the outcome data of the Candian inception cohort, where 50% of patients had no disease activity at 6 month follow up (4). A median of 4 active joints at onset and a median delay to diagnosis of 6 months adversely affected the outcome.Of our cohort, 93% of patients had no or mild disability.These outcomes were achieved with a treat to target philosophy where more than75% of patients did not receive a BRM. It is thus possible for children with JIA in the developing world also to have outcomes comparable with western children <h3>References</h3> Wallace CA, Ruperto N, Giannini E. Preliminary Criteria for Clinical Remission for Select Categories of Juvenile Idiopathic Arthritis.J Rheumatol 2004;31;2290-2294 Giannini EH, Ruperto N, Ravelli A, Lovell DJ, Felson DT, Martini A. Preliminary definition of improvement in juvenile arthritis.Arthritis Rheum.1997 Jul;40(7):1202-1209 Dempster H, Porepa M, Young N, Feldman BM. The clinical meaning of functional outcome scores in children with juvenile arthritis. Arthritis and rheumatism.2001 Aug;44(8):1768-1774 Oen K, Duffy CM, Tse SM, Ramsey S, Ellsworth J, Chédeville G et al. Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort.Arthritis Care Res (Hoboken). 2010 Apr;62(4):527-536 <h3>Disclosure of Interest</h3> None Declared