Prognosis

Prognosis of JIA has improved significantly in the past 10-20 years due to several factors

• development of new therapies such as biological therapeutics
• early aggressive treatment
• effective intra-articular administration of steroids
• involvement of multidisciplinary team (1,2)

Despite these factors help in better management of the condition, some patients still have an active disease with a progressive clinical course.

• In a cohort study of 683 JIA patients, 32.8% were in remission after a mean follow-up of 10 years (remission being defined as no disease activity in the absence of antirheumatic medications for at least 6 months)
  • polyarticular subtype, making up 15.8% of the cohort, attained remission in 24.1% of patients at some time in the disease course
  • none of the RF-positive patients achieved remission during the time course studied
• a similar study in 392 JIA patients determined the probability of remission (defined as absence of arthritis off treatment for at least 2 years) at 10 years was
  • 23% for RF-negative polyarticular patients
  • 6% for RF-positive polyarticular patients

Poor prognosis is seen in following patients

• for polyarticular JIA
  • positive RF antibodies
  • positive anti cyclic citrullinated peptide (anti-CCP) antibodies
  • hip arthritis
  • cervical spine arthritis
  • erosions or joint space narrowing on radiographs
• enthesitis related arthritis
  • family history of the disease
  • early ankle and hip joint involvement
  • a higher number of affected joints at disease onset
• systemic JIA
  • age of onset less than 6 years
  • disease duration for greater than 5 years, or persistent systemic features at 6 months of disease including fever
  • the need for corticosteroids
  • thrombocytosis (1,2,3).

Reference:

• (1) Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis – epidemiology and management approaches. Clinical Epidemiology. 2014;6:379-393.
• (2) Barut K, Adrovic A, Şahin S, Kasapçopur Ö. Juvenile Idiopathic Arthritis. Balkan Medical Journal. 2017;34(2):90-101.
• (3) Kahn P.Juvenile idiopathic arthritis - an update on pharmacotherapy. Bull NYU Hosp Jt Dis. 2011;69(3):264-76.