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Enthesitis linked to worse patient-reported outcomes regardless of JIA category
Children with enthesitis demonstrate worse patient-reported outcomes compared with those without, regardless of their category of juvenile idiopathic arthritis, according to data published in Arthritis Care & Research.
“Key limitations of previous studies of [patient-reported outcomes] in JIA include limited sample size and follow up time for longitudinal cohorts, or use of cross-sectional data and a low prevalence of enthesitis,” Dax G. Rumsey, MD, MSc, of the University of Alberta School of Public Health in Canada, and colleagues wrote. “Further, according to current [International League of Associations for Rheumatology (ILAR)] criteria, it is possible to have [enthesitis-related arthritis] without having enthesitis. In adults, enthesitis is known to negatively affect quality of life.”
To analyze the impact of enthesitis on patient-reported outcomes among children with JIA, across various JIA categories, Rumsey and colleagues studied data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACChOut) cohort. In that cohort, 1,497 children with JIA, recruited from 16 Canadian facilities from 2005 to 2010, were followed for up to 5 years. Rumsey and colleagues evaluated data on 1,371 of these patients, who had provided at least one patient-reported outcome during a median follow-up of 35.3 months.
Each participant was evaluated by a physician for entheseal tenderness in 33 defined locations at enrollment as well as every 6 months for 2 years, and then annually for up to 5 years. During these same times, participants were assessed using the Juvenile Arthritis Quality of life Questionnaire (JAQQ), Quality of My Life questionnaire (QoML), Childhood Health Assessment Questionnaire (CHAQ) and a pain visual analogue scale (VAS). Final analysis included descriptive statistics, linear mixed models for longitudinal data and an analysis of covariance.
According to the researchers, 214 of the 1,317 patients included in the study had a diagnosis of enthesitis, of whom 64% were classified as demonstrating enthesitisrelated arthritis. Juveniles with enthesitis reported higher JAQQ scores, with a mean raw score of 2.71 compared with 2.16 for those without (adjusted difference = 0.41 points; 95% CI, 0.22-0.59). Children with enthesitis similarly reported higher CHAQ scores, with 0.47 points compared with 0.31 points for those without (adjusted difference = 0.14; 95% CI, 0.07-0.22); higher pain, with 3.01 points compared with 1.68 points in those without (adjusted difference = 0.94; 95% CI, 0.64-1.25); and lower QoML scores, with 7.02 points compared with 8.23 points among those without (adjusted difference = –0.8; 95% CI, –1.09 to –0.51). These differences were found after adjusting for JIA category, and persisted up to 5 years.
“This has important implications,” Rumsey and colleagues wrote. “Because enthesitis impacts patient well-being, physicians should ascertain its presence in every child with JIA and address it if present. These are crucial steps should we wish to heed what these children and families are telling us and hope to improve their pain, function, and quality of life.” – by Jason Laday
Disclosure: Rumsey reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.