AB1021 CURRENT COURSE OF JUVENILE ARTHRITIS AND ASSESSMENT OF PHYSICAL DEVELOPMENT OF CHILDREN
Authors: Nadiia Melanchuk, Olena Oshlianska
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Appointment of modern methods of treatment led to a modification of the course of juvenile idiopathic arthritis (JIA). In Ukraine, the basic preparations were prescribed at JIA since 1984, then the biological registered only in 2011 <h3>Objectives</h3> To evaluate the effect of treatment changes on activity indicators, functional disorders and physical development of patients with JIA. Methods: retrospective analysis of medical records of 67 patients in 2018 and compared with the data of the clinical registry of the department in 1997-2010 (231 children). The diagnosis of JIA is based on the PRINTO criteria, the evaluation of the activity was performed for JADAS27, the JADI functional disturbances, the linear growth delay was estimated for SD, the BMI calculation using the Kettl formula was performed. <h3>Results</h3> The analysis showed that the structure of sub-variants of JIA during the 20 yrs. did not significantly change (10.6% sJIA, 31.9% oJIA, 8.5% RF+pJIA, 29.8% RF-pJIA, 12.8% of the eA). Compared to the historical control group, there was a decrease in the total no. of affected joints, which increased with age (from 4.92±0.7 in 1-6 yrs. to 7.7±1.8 in adolescents now compared with 5.33±0.8 &amp; 14,3±1,02 in the past). The max. no. of injured joints was at RF+pJIA (17.0±2.9), and 38.3% of the limbs were deformed. In recent years, JIA did not show visceral lesions (12.8% in past). JADAS27 was generally low, the max. for sJIA 7,1±5,0, eA 6,7±0,79, and RF-pJIA 6,5±1,04. The greater activity of the disease was observed on average in children aged 10-14 y, 5,8±0,9 (3,3±0,9 at 6-10 &amp; 5.0±1.3 in 1-6 y). The race was the best in oJIA: an acceptable state of symptoms was 27%, a lack of activity of 27%, while with pJIA in 40% - high activity of the disease. Indicator JADAS27 did not significantly depend on serological features: ANA+ 3.9+0.6 (r=-0.06), RF+ 4.5±1.0 (r=-0.2), HLA B27 7.2±0.8 (r=0.05), sero-neg. 4.9±0.6 (r=-0.6). In cases of relapse or persistence of active inflammation in patients with ≥5 y, JADAS27 was lower when DMARDS was administered before 3 mo. from the debut of the disease (1.8±1.2 vs. 3.5±0.7). In patients with high disease activity, the combination of DMARDS and sCS was worse in the first 6 mo. from the debut (JADAS 6.6±1.2- 5.5±1.7) than DMARDS + ADA (4.0± 2.3 - 0,0) and DMARDS + TOCY (5,2±1,2 - 3,6±1,3). The max. JADI were in RF-pJIA (2,0±1,3), in general, JADI increased with age (&lt;6y 0.55±0.3; &gt;10y 1.7±0.9). JADI didn`t depend on the onset age (r=-0.12), disease duration (r=0.16), ANA detection (1.8±1.1; r=0.18), the RF (1.2±0.5; r=0.07); HLA B27 0.5±0.3 (r=-0.1); seronegative (1.02±0.4; r=0.07). In patients last years of FI II-III cen. marked with a higher frequency of 35.9%. A smaller proportion of patients with growth retardation was observed than in previous yrs. (10.4 vs 49%). The delay in linear growth with JIA is -1.37±0.06SD now, the degree of growth retardation depends on the duration of the disease (up to 3y -1.2±0.1, 8-13y 1.6±0.07) and the variant of the course (the max. growth retardation rate observed in sJIA (78% to -1.2SD; 11% -3SD). The DMARDS+sCS+TZ in high activity JIA and growth retardation was better for normalizing the growth (-0.94±0.04SD after 2y) compared to DMARDS+sCS+ADA (-1.3±0,4). On average, BMI at JIA did not differ from the age norm (17.8±0.7; 48% cases with overweight in last). DMARDS in higher doses was better for the normalization of BMI (MTX 15 mg/m<sup>2</sup> 17.1±1.2; 10 mg/m<sup>2</sup> 19.2±1.9). The use of ADA in patients with malnutrition resulted in 6 mo. to normalization of the BMI (18,55±1,5) in contrast to the use of ETA (16,52±0,1). <h3>Conclusion</h3> The results obtained show that the overall activity of JIA is significantly reduced today. Improvement of the course of JIA and the degree of functional impairment is explained by the introduction of modern methods of pathogenetic therapy into the clinical practice. <h3>Disclosure of Interests</h3> None declared