Article Text
Abstract
Objective To describe the course and the 4-year outcome of juvenile spondyloarthritis (jSpA).
Methods Patients with a diagnosis of jSpA and an age at onset ≤16 years were included in the German Spondyloarthritis Inception cohort (GESPIC) and followed up prospectively for 4 years.
Results 118 patients (73% men, 66% HLA-B27 positive, mean age 13.5 years, mean symptom duration 2.2 years) were enrolled in 2 study centres: 52% of patients with jSpA were captured by the enthesitis-related arthritis subgroup of the International League of Associations for Rheumatology classification criteria. At inclusion, the majority of patients had active peripheral arthritis (75.4%), followed by inflammatory back pain (IBP) (19.5%) and enthesitis (16.1%). There was a significant improvement in clinical manifestations and in patient-reported outcomes over time. During the 4-year follow-up, 85% of the patients had at least 1 period of remission on drug ≥6 months, and 46% of the patients achieved remission ≥12 months without medication, of whom 68% kept this status and 32% worsened. At the end of 4 years of observation, 23% of the patients were in remission without medication, but 57% still suffered from active disease. Patients with peripheral arthritis had a likelihood of 29% for having peripheral arthritis after 4 years, whereas the likelihood of IBP persistence was 53% for those with IBP at enrolment.
Conclusions Although 1 quarter of patients with jSpA achieved remission off medication after 4 years, the likelihood of having recurrent or persistent disease into adulthood is substantial, particularly for jSpA with IBP.
Trial registration number NCT 01277419.
- Spondyloarthritis
- Ankylosing Spondylitis
- Arthritis
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Footnotes
Contributors AW performed data analysis, statistical analysis, prepared tables and figures and wrote the draft manuscript. KM took care of study patients, was involved in data interpretation and manuscript preparation. JL performed statistical analysis, data interpretation and was involved in manuscript preparation. IF took care of after study patients. JS was responsible for getting funding of the trial, designed the study and was involved in manuscript preparation. MR was responsible for getting funding of the trial, designed the study and was involved in data interpretation and manuscript preparation. All authors read and approved the final manuscript.
Funding As part of the German Competence Network in Rheumatology (Kompetenznetz Rheuma), GESPIC has been financially supported by the Bundesministerium für Bildung und Forschung (BMBF), FKZ 01G19946.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethics Commission of the Freie Universität Berlin.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.