Title: Analysis of Comorbid Diseases in Children with Juvenile Idiopathic Arthritis and Their Effects on the Disease Process

Year 2023, Volume: 7 Issue: 3, 288 - 295, 20.12.2023

Nihal Şahin , Sevda Asadova Sema Nur Taşkın Şeyda Doğantan , Sümeyra Özdemir Çiçek , Ayşenur Paç Kısaarslan , Hakan Poyrazoğlu

https://doi.org/10.46332/aemj.1207568

Abstract

Purpose: Comorbidities are conditions that exist or occur during an index disease course. Comorbidities may affect the chronic disease process. Juvenile idiopathic arthritis (JIA) is a chronic childhood arthritis of unknown etiology. We aimed to evaluate comorbidities associated with JIA and their effects on the course of the disease.

Materials and Methods: We included patients under 18 years of age with JIA in our center between 2005 and 2021. All diseases accompanying JIA and recorded in the medical records were considered as comorbidities. JIA disease activity indexes (JADAS27, JSPADAS), damage index (JADI-A, JADI-E), and health assessment questionnaire index (CHAQ) and JIA treatments were compared according to the presence of comorbidity.

Results: Two hundred and four patients were included in the study. The median age was 13(4-17.5) years, and the median follow-up time was 5(2-16) years. Ninety-nine (48.5%) patients had at least one comorbidity. Twenty-four patients had more than one comorbidity. The most common comorbidity was FMF (n=31 (15.2%)), followed by uveitis in 23 (11.3%). JADAS 27, and JSPADAS were indifferent in patients with comorbidity (p=0.55, p=0.63, respectively). JADI-A, JADI-E, and CHAQ scores were similar in the two groups (JADI-A:p=0.45; JADI-E:p=0.11; CHAQ disability:p=0.62; CHAQ discomfort:p=0.61; CHAQ pain:p=0.32). Forty-two (42.4%) patients with comorbidities and 43 (41%) patients without comorbidity used biological drugs (p=0.83). Adalimumab treatment was higher in those with comorbidity (patients with comorbidity:n=22 (22.2%); without comorbidity:n=11 (10.5%); p=0.02).

Conclusion: Although comorbidity did not affect disease activity, damage score, and Health Assessment Questionnaire index, the JIA treatment varied according to comorbidity.

Keywords

arthritis, chronic disease, comorbidity, juvenile

Juvenil İdiopatik Artritli Çocuklarda Komorbid Hastalıkların Analizi ve Hastalık Sürecine Etkisi

Abstract

Amaç: Komorbiditeler bir indeks hastalığın seyrinde var olan ya da sonradan ortaya çıkan durumlar olarak tanımlanır. Kronik hastalıklarda eşlik eden komorbidite varlığı hastalık sürecine etki edebilir. Juvenil idiopatik artrit (JİA) çocukluk çağının nedeni belli olmayan kronik artritidir. Bu çalışmada JİA hastalarında eşlik eden komorbiditeleri incelemek ve hastalık seyrine etkilerini araştırmak amaçlandı.

Araçlar ve Yöntem: 2005-2021 yıllarında merkezimizde takip edilen ILAR kriterlerine göre JİA tanısı almış 18 yaş altındaki hastalar dahil edildi. JİA’ya eşlik eden tıbbi dosyalara kaydedilmiş tüm ek hastalıklar komorbidite olarak değerlendirildi. Komorbidite eşlik eden ve etmeyen hastalarda JİA hastalık aktivite (JADAS27, JSPADAS), hasar (JADI-A, JADI-E) ve sağlık değerlendirme anket (CHAQ) skorları ve JİA tedavileri karşılaştırıldı.

Bulgular: Çalışmada 204 hasta vardı. Hastaların yaş ortanca değeri 13 (4-17.5) yıl, takip süresi ortanca değeri 5 (2-16) yıl idi. Hastaların 99’unda (%48.5) en az bir komorbidite saptandı. Birden fazla komorbidite saptanan hasta sayısı 24 (%11.8) idi. En sık saptanan komorbidite AAA (n=31 (%15.2)) idi. Ardından 23 (%11.3) hastada üveit vardı. JADAS 27, JSPADAS skorları komorbidite varlığına göre farklılık göstermedi (sırasıyla, p=0.55, p=0.63). İki grup arasında JADI-A, JADI-E skorlarında farklılık yoktu (sırasıyla, p=0.45, p=0.11). CHAQ skoru da komorbidite olanlarda farklı değildi (CHAQ disability: p=0.62; CHAQ discomfort: p=0.61; CHAQ pain: p= 0.32). Biyolojik ilaç kullanımı komorbidite olanlarda 42 (%42.4), olmayanlarda 43 (%41) idi (p=0.83). Adalimumab kullanımı komorbidite eşlik edenlerde daha fazlaydı (Komorbidite olanlarda: n=22 (%22.2); olmayanlarda: n=11 (%10.5); (p=0.02)).

Sonuç: Komorbidite varlığının hastalık aktivite, hasar ve sağlık değerlendirme anket skorlarına etkisi saptanmamasına rağmen komorbidite varlığına göre JİA tedavi seçimi değişmektedir.

Keywords

chronic disease, arthritis, comorbidity, juvenile

Supporting Institution

YOK

References

• 1. Kimura Y, Vastert SJ. Systemic juvenile idiopathic arthritis. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn LR. Textbook of Pediatric Rheumatology ed. Elsevier. 2021;216-227.
• 2. Fujikawa S, Okuni M. A nationwide surveillance study of rheumatic diseases among Japanese children. Acta Paediatr Jpn Overseas Ed. 1997;39(2):242-244.
• 3. Moe N, Rygg M. Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study. Clin Expeimental Rheumatol. 1998;16(1):99-101.
• 4. Radner H, Yoshida K, Smolen JS, Solomon DH. Multimorbidity and rheumatic conditions-enhancing the concept of comorbidity. Nat Rev Rheumatol. 2014;10(4):252-256.
• 5. Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014;73(1):62-68.
• 6. Radner H, Yoshida K, Hmamouchi I, Dougados M, Smolen JS, Solomon DH. Treatment Patterns of Multimorbid Patients with Rheumatoid Arthritis: Results from an International Cross-sectional Study. J Rheumatol. 2015;42(7):1099-1104.
• 7. Han GM, Han XF. Comorbid conditions are associated with healthcare utilization, medical charges and mortality of patients with rheumatoid arthritis. Clin Rheumatol. 2016;35(6):1483-1492.
• 8. Jacobsson LTH, Knowler WC, Pillemer S, et al. Rheumatoid arthritis and mortality. A longitudinal study in pima indians. Arthritis Rheum. 1993;36(8):1045-1053.
• 9. Meune C, Touzé E, Trinquart L, Allanore Y. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford). 2009;48(10):1309-1313.
• 10. Raab A, Sengler C, Niewerth M, et al. Comorbidity profiles among adult patients with juvenile idiopathic arthritis: Results of a biologic register. Clin Exp Rheumatol. 2013;31(5):796-802.
• 11. Robazzi TC, Adan LF, Pimentel K, et al. Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever. Clin Exp Rheumatol. 2013;31(2):310-317.
• 12. Smith EMD, Foster HE, Beresford MW. Adding to complexity: comorbidity in paediatric rheumatic disease. Rheumatology. 2013;52(1):22-33.
• 13. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390-392.
• 14. Livneh A, Langevitz P, Zemer D, et al. Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum. 1997;40(10):1879-1885.
• 15. Yalçinkaya F, Özen S, Özçakar ZB, et al. A new set of criteria for the diagnosis of familial Mediterranean fever in childhood. Rheumatology. 2009;48(4):395-398.
• 16. Lovell DJ, Huang B, Chen C, Angeles-Han ST, Simon TA, Brunner HI. Prevalence of autoimmune diseases and other associated conditions in children and young adults with juvenile idiopathic arthritis. RMD open. 2021;7(1):e001435.
• 17. Gabriel SE, Crowson CS, O’Fallon WM. Comorbidity in arthritis. J Rheumatol. 1999;26(11):2475-2479.
• 18. Mease PJ, Menter MA. Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective. J Am Acad Dermatol. 2006;54(4):685-704.
• 19. Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W. The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes. 2009;7(1):1-12.
• 20. Han GM, Han XF. Comorbid conditions are associated with healthcare utilization, medical charges and mortality of patients with rheumatoid arthritis. Clin Rheumatol. 2016;35(6):1483-1492.
• 21. Pelajo CF, Lopez-Benitez JM, Miller LC. Obesity and disease activity in juvenile idiopathic arthritis. Pediatr. Rheumatol. 2012;10(1):1-5.
• 22. Guo R, Cao L, Kong X, Xue H, Li X, Shen L. Atopy in children with the enthesitis-related arthritis (ERA) subtype of juvenile idiopathic arthritis is associated with a worse outcome. Eur J Pediatr. 2015;174(11):1441-1450.
• 23. Mena-Vázquez N, Cabezudo-García P, Ortiz-Márquez F, et al. Evaluation of cognitive function in adult patients with juvenile idiopathic arthritis. Int J Rheum Dis. 2021;24(1):81-89.
• 24. Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra-articular manifestations in RA and their impact on outcome. Rheumatology (Oxford). 2013;52(1):99-110.
• 25. Sahin S, Acari C, Sonmez HE, et al. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol. 2021; 19(1):1-10.
• 26. Demirkaya E, Özen S, Bilginer Y, et al. The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: Results from the registry of the Turkish paediatric rheumatology association. Clin Exp Rheumatol. 2011;29(1):111-116.
• 27. Paç Kısaarslan A, Özdemir Çiçek S, Şahin N, et al. Ailevi Akdeniz Ateşi Tanısına Eşlik Eden Hastalıklar: Tek Merkez Deneyimi/Diseases Accompanying Familial Mediterranean Fever: A Single-centre Experıence. Bozok Tıp Derg. 2020;10(2):105-110.
• 28. Breitbach M, Tappeiner C, Böhm MRR, et al. Discontinuation of long-term adalimumab treatment in patients with juvenile idiopathic arthritis-associated uveitis. Graefe’s Arch Clin Exp Ophthalmol. 2016;255(1): 171-177.
• 29. Sen ES, Ramanan A V. Juvenile idiopathic arthritis-associated uveitis. Clin Immunol. 2020;211:108322.
• 30. Ringold S, Weiss PF, Beukelman T, et al. 2013 Update of the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for the Medical Therapy of Children With Systemic Juvenile Idiopathic Arthritis and Tuberculosis Screening Among Children Receiving Biologic Medications. Arthrıtıs Rheum. 2013;65(10):2499-2512.
• 31. Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Rheumatol. 2019;71(6):846-863.
• 32. Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019;71(6):717-734.
• 33. Kip MMA, De Roock S, Currie G, et al. Pharmacological treatment patterns in patients with juvenile idiopathic arthritis in the Netherlands: a real-world data analysis. Rheumatol. 2023;62(SI2):SI170-SI1.