Family history of autoimmune disease a risk factor for juvenile idiopathic arthritis
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Family history of autoimmune disease is a risk factor for developing of juvenile idiopathic arthritis, although it does not impact disease severity or course, according to data published in Pediatric Rheumatology.
“The aim of this study was to provide a comprehensive overview of autoimmune diseases in parents of children with JIA and related factors, since this was previously not available,” Joeri W. van Straalen, MSc, of the department of pediatric immunology and rheumatology at Wilhelmina Children’s Hospital, in the Netherlands, told Healio.
To investigate the presence of autoimmune diseases among parents of children with JIA, van Straalen and colleagues collected and analyzed data from the Pharmachild registry. According to the researchers, this registry collects data from patients enrolled through the Pediatric Rheumatology International Trials Organization across 31 countries. To be included in this analysis, patients were required to meet the criteria for JIA according to the International League of Associations for Rheumatology. Additionally, patients needed to be receiving either NSAIDs, intra-articular steroids, systemic steroids and/or conventional-synthetic or biologic disease-modifying antirheumatic drugs.
Meanwhile, patients were excluded if there was no available information regarding family history. Data were collected through Nov. 12, 2020.
The researchers reviewed files from patients whose diseases were reported in first degree relatives, including mothers and fathers, to make sure that the analysis only included “definitive diagnoses” of autoimmune diseases, they wrote. Included diseases were categorized into several categories, including, but not limited to, psoriasis, rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, JIA, asthma, systemic lupus erythematous, vitiligo, celiac disease, uveitis, rheumatic fever, vasculitis and familiar Mediterranean fever.
Additionally, the researchers collected patient characteristics including sex, geographic location, ethnicity and age of JIA onset. The number of active joints, as well as clinical juvenile arthritis disease activity score, at the time of enrollment and at the last follow-up visit were also included.
The analysis included a total of 8,673 patients. According to the researchers, parents of children with JIA were more likely to have a higher prevalence of several autoimmune diseases compared with the general population. The most common autoimmune diseases present in the familial history were psoriasis, autoimmune thyroid disease, RA and AS.
However, patients’ juvenile arthritis disease activity scores were not statistically significantly different between those with and without familial histories of autoimmune diseases. Familial histories of autoimmune disease were associated with older age at JIA onset (P < .01), Scandinavian residence (P < .01), arthritis (P < .01), ANA-positivity (P = .03) and HLA-B27 positivity (P < .01).
“Autoimmune diseases are more common in parents of children with JIA compared to the general population and a family history of autoimmune disease is particularly associated with psoriatic, undifferentiated and enthesitis-related arthritis,” van Straalen said. “This could be useful information for pediatric rheumatologists at the diagnosis stage of a child with possible JIA. Furthermore, the results of our study indicate that a family history of autoimmune disease does not influence the severity or course of JIA.”
Perspective
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Pediatric rheumatology providers need to use all available tools when diagnosing children with an autoimmune disease. Understandably, the focus during clinic visits centers around the child’s symptoms, test results and response to therapy. Straalen and colleagues remind us of the importance of obtaining the family history, as it may identify important risk factors that could aid in the diagnosis of juvenile idiopathic arthritis.
This study looked at the prevalence of autoimmune disease in the parents of children with JIA, finding that for children with JIA, there is a higher incidence of a parent having an autoimmune disease than in the general population. Interestingly the most common autoimmune diseases among parents were psoriasis, autoimmune thyroid disease, rheumatoid arthritis and ankylosing spondylitis.
Limitations to the study included not differentiating between autoimmune disease in mothers vs. fathers and the exclusion of siblings. Overall, the results of this study support previous findings and increase our understanding of the complex nature of JIA.
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