Prognostic factors for radiographic progression, radiographic damage, & disability in JRA

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Prognostic factors for radiographic progression, radiographic damage,

and disability in juvenile idiopathic arthritis

Arthritis & Rheumatism Volume 48, Issue 12 , Pages 3509 - 3517

Copyright © 2003 by the American College of Rheumatology

http://www3.interscience.wiley.com/cgi-bin/abstract/106570266/ABSTRACT

Abstract

Objective

To investigate the rate of radiographic progression and identify

prognostic factors of radiographic progression, radiographic damage, and

physical disability in juvenile idiopathic arthritis (JIA).

Methods

Ninety-four JIA patients with a median disease duration of 1.1 years

were followed up prospectively for a median of 4.5 years. Bilateral

wrist radiographs were obtained at baseline, at 1 year, and at the last

followup visit. Radiographic damage was assessed by the carpal length

(Poznanski score), and physical disability by the Childhood Health

Assessment Questionnaire (C-HAQ). Yearly radiographic progression, the

Poznanski score at the final visit, and the C-HAQ score at the final

visit were used as outcome measures. Baseline parameters included

demographic, clinical, laboratory, and radiographic data.

Results

The mean ± SD Poznanski score was -1.2 ± 1.3 at baseline, -1.7 ± 1.8 at

the 1-year visit, and -1.9 ± 2.2 at the final visit (P < 0.0001).

Radiographic progression was greater during the first year (mean ± SD

-0.5 ± 1.1) than between the 1-year visit and the final visit (-0.2 ±

1.3). The mean yearly radiographic progression during the entire study

period was -0.1 ± 0.4. Logistic regression analysis revealed that

radiographic progression during the first year was the only baseline

parameter that was predictive of all 3 study outcomes. The final

Poznanski score was also predicted by the baseline Poznanski score,

whereas female sex was protective against radiographic progression.

Conclusion

We identified the prognostic factors for poorer outcome in

polyarticular-course JIA. The changes in the early Poznanski score can

be used to predict long-term joint damage and physical disability.

Silvia Magni-Manzoni 1, Federica Rossi 2, Pistorio 3, Francesca

Temporini 1, Stefania Viola 2, Giampiero Beluffi 1, Alberto i 2,

Angelo Ravelli 2 *

1Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S.

Matteo, Pavia, Italy

2Università di Genova, and Istituto di Ricovero e Cura a Carattere

Scientifico G. Gaslini, Genoa, Italy

3Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genoa,

Italy

email: Angelo Ravelli (angelorav)

*Correspondence to Angelo Ravelli, Istituto G. Gaslini, Largo G. Gaslini

5, Genoa 16147, Italy