Changing Patterns in Treatment, Remission Status, and Categories in a Long-Term Nordic Cohort Study of Juvenile Idiopathic Arthritis.

OBJECTIVE: To explore sustainability of achieved remission off medication and defined International League of Associations for Rheumatology (ILAR) categories in juvenile idiopathic arthritis (JIA) and describe the trajectory of disease course over time by comparing treatment, disease activity, and ILAR categories from baseline, 8 years, and 18 years after disease onset. METHODS: A total of 373 of the 510 included patients were initially recruited consecutive cases of JIA from the prospective, longitudinal, population-based Nordic JIA cohort with disease onset during 1997-2000 from Denmark, Norway, Sweden, and Finland in an 18-year follow-up study. Clinical data were collected consecutively at baseline, 8 years, and 18 years after disease onset and were evaluated regarding treatment, disease activity, and ILAR category. RESULTS: Significantly more patients (70%) were off medication after 18 years of follow-up compared to after 8 years (59.7%); nevertheless, the number of patients in remission had not increased (52% off medication versus 51% on medication). Twelve percent of patients changed ILAR category between 8 years and 18 years after disease onset. Almost half of the changes were due to updated information about heredity in a first-degree relative. In the same period, the psoriatic arthritis group increased significantly in number (P < 0.001), in contrast to the oligoarticular category, which decreased (P = 0.02). The undifferentiated group increased 24% from 8 to 18 years of follow-up; however, this increase was not significant (P = 0.06). CONCLUSION: In this Nordic JIA cohort study, the remission rate did not increase even though significantly more patients were off medication at the 18-year follow-up compared to at the 8-year follow-up after disease onset. The distribution of patients in the ILAR categories continued to change significantly throughout the 18-year study period.

Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study.

PURPOSE: To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA). DESIGN: Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA. PARTICIPANTS: A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden. METHODS: Patients with onset of JIA between January 1997 and June 2000 were prospectively followed for 18 years. Pediatric rheumatologists and ophthalmologists collected clinical and laboratory data. MAIN OUTCOME MEASURES: Cumulative incidence of uveitis and clinical characteristics, JIA and uveitis disease activity, ocular complications, visual outcome, and risk factors associated with the development of uveitis-related complications. RESULTS: Uveitis developed in 96 (22.1%) of 434 patients with JIA. In 12 patients (2.8%), uveitis was diagnosed between 8 and 18 years of follow-up. Systemic immunosuppressive medication was more common among patients with uveitis (47/96 [49.0%]) compared with patients without uveitis (78/338 [23.1%]). Active uveitis was present in 19 of 78 patients (24.4%) at the 18-year visit. Ocular complications occurred in 31 of 80 patients (38.8%). Short duration between the onset of JIA and the diagnosis of uveitis was a risk factor for developing ocular complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8). Patients with a diagnosis of uveitis before the onset of JIA all developed cataract and had an OR for development of glaucoma of 31.5 (95% CI, 3.6-274). Presence of antinuclear antibodies (ANAs) was also a risk factor for developing 1 or more ocular complications (OR, 3.0; 95% CI, 1.2-7.7). Decreased visual acuity (VA) <6/12 was found in 12 of 135 eyes (8.9%) with uveitis, and 4 of 80 patients (5.0%) with JIA-U had binocular decreased VA <6/12. CONCLUSIONS: Our results suggest that uveitis screening should start immediately when the diagnosis of JIA is suspected or confirmed and be continued for more than 8 years after the diagnosis of JIA. Timely systemic immunosuppressive treatment in patients with a high risk of developing ocular complications must be considered early in the disease course to gain rapid control of ocular inflammation.