Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC

Anja Weiß, Kirsten Minden, Joachim Listing, Ivan Foeldvari, Joachim Sieper, Martin Rudwaleit, Anja Weiß, Kirsten Minden, Joachim Listing, Ivan Foeldvari, Joachim Sieper, Martin Rudwaleit

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.

Trial registration: ClinicalTrials.gov NCT01277419.

Keywords: Ankylosing Spondylitis; Arthritis; Spondyloarthritis.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Cumulative likelihood of achieving remission on and off medication. (B) Transition probabilities: left: transition probability of a status in remission on medication; right: transition probability of a status in remission off medication.

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