AT EULAR 2017
MADRID (FRONTLINE MEDICAL NEWS) – More than half of young adults with juvenile idiopathic arthritis have comorbid conditions that impact their daily quality of life.
The issues range from directly disease-related – like uveitis – to more tangentially associated problems, like depression, Kirsten Minden , MD, said at the European Congress of Rheumatology.
“These comorbidities significantly impact the lives of young patients with JIA, but are under-recognized and under-reported by adult rheumatologists. Guidance on risk assessment in adults with JIA is needed,” said Dr. Minden of the German Rheumatism Research Centre, Berlin.
She discussed the findings of two large German registries, Biologika in der Kinder-Rheumatologie (BiKeR) and Juvenile Arthritis-Methotrexate/Biologics Long-Term Observation (JUMBO).
Children enter BiKeR as soon as they receive a JIA diagnosis; they transfer to JuMBO when they turn 18 years old. Since 2001, 1,022 children have transitioned from the pediatric to young adult databases.
These patients are largely female (68%), with a mean age of 23 years and a mean disease duration of 13 years. Most (77%) had received at least one biologic disease-modifying anti-rheumatic drug; the mean number of those drugs received was 3. They were diagnosed with a wide variety of juvenile arthritis subtypes: polyarthritis RF-negative (27%); enthesitis-related (20%); extended oligoarthritis (17%); polyarthritis RF-positive (9%); psoriatic arthritis (9%); persistent oligoarthritis (9%); and systemic arthritis (5%). The remainder had other subtypes.
More than half of the patients had at least one comorbidity; the mean number of issues per patient was two. Eye disorders were most common (17%), with uveitis making up 16% of that. Immune disorders were also common (12%), Psychiatric disorders occurred in 10%, with most of that (9%) being depression. Another 9% had skin or subcutaneous tissue disorders, including psoriasis (3%).
Autoimmune thyroiditis occurred in 2.5%, as did inflammatory bowel disease. General gastrointestinal disorders were present in 5%.
Men and women experienced different comorbidity clusters. Depression was more common among women (12% vs. 3%), as were pain disorders (6% vs. 2%) and autoimmune disorders (3% vs. 1%). Men, however, experienced more inflammatory bowel disease than women (4% vs. 2%).
Comorbidities were also expressed differently among the different JIA subtypes. Those with systemic disease were more likely to have hypertension (21%), osteoporosis (10%), and amyloidosis (4%). Uveitis was most common among those with extended oligoarthritis (35%). Psoriasis was most common among those with psoriatic arthritis (20%).
A progressive enrollment assessment showed some encouraging trends, however. The patients who enrolled in the earliest epoch (2001-2005) were also oldest at initial assessment (26). The majority of those (71%) had at least one comorbidity. But from 2006-2009, patients were younger when assessed, and fewer had comorbidities (55%). In the last epoch of 2010-2016, patients were a mean of 20 when assessed, and about 45% endorsed at least one comorbidity.
Hypertension, uveitis, and depression have all decreased since the first epoch, Dr. Minden noted Hypertension has gone down from a rate of 21% in 2001-2005 to 13% most recently. Depression declined from 11.5%-6%, and uveitis, from 17%-2%
This improvement, she said, may reflect newer trends in earlier diagnosis, earlier treatment, and more effective disease-modifying drugs.
“Age and disease duration do play a role in the presence of comorbidities, but whether the lower rates are due to younger age now is questionable,” she said. “It may be that the decreasing rates are due to earlier and better treatment strategies, and we are analyzing this now.”
A key finding supports this hypothesis, she noted.
“When we look at the presence of short stature over time, we can be encouraged about this. In the earliest period, 5% had short stature. That is now seen in less than 1% of our patients enrolled in the last decade.”
Dr. Minden is on the speakers bureau of Pfizer, Roche, and Pharm-Allergan. BiKeR is funded by unconditional grants from Abbvie, Germany, Novartis, Germany, and Roche, Germany, JuMBO by unconditional grants from Abbvie, Pfizer, and Roch
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