Assessment of the Damage Index and Its Dynamics in Patients with Non-Systemic Variants of Juvenile Arthritis during the Treatment with Biologics.

IF 0.8 4区 生物学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY
Z A Kolkhidova, I P Nikishina, S I Glukhova
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引用次数: 0

Abstract

Juvenile idiopathic arthritis (JIA) is characterized by a high risk of joint destruction, extra-articular changes, and rapidly progressive disability. The CHAQ (Childhood Health Assessment Questionnaire) and  X-ray are often used to assess functional impairment and the degree of irreversible damage, but both methods have limitations. The Juvenile Arthritis Damage Index (JADI) has been developed to comprehensively assess the biological prognosis of JIA, which includes articular (JADI-A) and extra-articular (JADI-E) damage evaluation. The use of the JADI may be an effective tool for predicting and monitoring the effectiveness of JIA therapy in real clinical practice conditions. THE AIM : of the study was to identify correlations of the JADI index with features of clinical manifestations in patients with non-systemic variants of JIA who had no experience with biologic therapy (B) and to evaluate the impact of lesions defined through the JADI damage index value on predicting response to B.

Materials and methods: . This open prospective study included 150 children with non-systemic JIA variants with no history of biologic therapy. The mean age was 12.2 ± 4.6 years, 60% were girls; 112 patients were examined in dynamics after 6 or 12 months from the beginning of therapy with biologics. Clinical and anamnestic evaluations, including detailed assessment of joint status and JADI-A and JADI-E scores, were performed on all patients.

Results: . The study showed that 50% of patients had damage on the JADI score, with 43% having JADI-A+ and 23% having JADI-E+. Both articular and extra-articular damage were present in 15% (n = 23) of children. Among those with JADI-A, flexion contractures of the knee joints were most frequently noted in 39%, elbow joints in 28%, and limitation of movement in the cervical spine in 26%. Extra-articular injuries were more frequently presented as avascular necrosis of bones, confirmed by imaging methods (41%), and a significant difference in limb length was observed in 35% of patients. The presence of articular changes was significantly associated with positivity for antinuclear antibody, rheumatoid factor, and anticyclic citrullinated peptide, as well as the absence of enthesitis, elevated erythrocyte sedimentation rate and С-reactive protein, high clinical activity, Juvenile Arthritis Disease Activity Score, CHAQ values, a history of glucocorticoid therapy, and low adherence to treatment. Polyarticular onset involving small hand joints and a tendency for rapid contracture formation were also associated with positive JADI-A values. The onset of polyarthritis with involvement of the small joints of the hands and a tendency to fast contracture formation were also associated with JADI-A positivity. As a result of therapy with biologics prescribed in routine clinical practice, the vast majority of patients achieved stable status without signs of damage or the value of the damage index remained unchanged. In 26 (23%) patients, JADI-A scores improved with complete resolution of contractures or increased amplitude of joint movement. In 10 (9%) cases, there was progression of the lesions with no established correlation with the choice of a specific drug, including 6 (5%) children with irreversible changes despite the use of targeted therapy.

Conclusions: : The JADI is a useful and accessible tool for clinical assessment of articular and extra-articular lesions, reflecting the prognosis of JIA and an objective indicator of therapy efficacy.

非全身性关节炎患者在生物制剂治疗期间损伤指数及其动态的评估。
青少年特发性关节炎(JIA)的特点是关节破坏、关节外改变和快速进行性残疾的高风险。CHAQ (Childhood Health Assessment Questionnaire,儿童健康评估问卷)和x射线常用于评估儿童的功能损害和不可逆损害程度,但这两种方法都有局限性。青少年关节炎损伤指数(JADI)是综合评价JIA生物学预后的指标,包括关节(JADI- a)和关节外(JADI- e)损伤评价。JADI的使用可能是预测和监测JIA治疗在实际临床实践条件下有效性的有效工具。本研究的目的是确定无生物治疗经验的非全体性JIA变异患者(B)的JADI指数与临床表现特征的相关性,并评估通过JADI损伤指数值定义的病变对预测B反应的影响。这项开放的前瞻性研究纳入了150名无生物治疗史的非全身性JIA变异儿童。平均年龄12.2±4.6岁,女孩占60%;112例患者在开始生物制剂治疗6或12个月后进行动态检查。对所有患者进行临床和记忆评估,包括关节状态和JADI-A和JADI-E评分的详细评估。结果:。研究表明,50%的患者JADI评分受损,43%的患者JADI- a +, 23%的患者JADI- e +。15% (n = 23)的儿童存在关节和关节外损伤。在JADI-A患者中,膝关节屈曲挛缩最常见(39%),肘关节最常见(28%),颈椎活动受限(26%)。关节外损伤更常表现为骨无血管性坏死,影像学证实(41%),35%的患者观察到肢体长度有显著差异。关节改变的存在与抗核抗体、类风湿因子和抗环瓜氨酸肽阳性、无炎症、红细胞沉降率和С-reactive蛋白升高、高临床活动性、幼年关节炎疾病活动性评分、CHAQ值、糖皮质激素治疗史和低治疗依从性显著相关。涉及小手关节的多关节发病和快速挛缩形成的趋势也与JADI-A值阳性相关。累及手部小关节的多关节炎的发病和快速挛缩形成的趋势也与JADI-A阳性有关。常规临床应用生物制剂治疗,绝大多数患者病情稳定,无损伤迹象或损伤指标值保持不变。在26例(23%)患者中,JADI-A评分随着挛缩的完全缓解或关节活动幅度的增加而改善。在10例(9%)病例中,病变的进展与特定药物的选择没有确定的相关性,其中包括6例(5%)儿童,尽管使用靶向治疗,但发生了不可逆的变化。结论:JADI是临床评估关节及关节外病变的一种实用易行的工具,反映了JIA的预后,是评价治疗效果的客观指标。
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来源期刊
Doklady Biochemistry and Biophysics
Doklady Biochemistry and Biophysics 生物-生化与分子生物学
CiteScore
1.60
自引率
12.50%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Doklady Biochemistry and Biophysics is a journal consisting of English translations of articles published in Russian in biochemistry and biophysics sections of the Russian-language journal Doklady Akademii Nauk. The journal''s goal is to publish the most significant new research in biochemistry and biophysics carried out in Russia today or in collaboration with Russian authors. The journal accepts only articles in the Russian language that are submitted or recommended by acting Russian or foreign members of the Russian Academy of Sciences. The journal does not accept direct submissions in English.
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