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Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis.
J Rheumatol. 2002 Nov; 29(11):2446-53.JR

Abstract

OBJECTIVE

To determine whether demographic, clinical, and laboratory variables at onset of arthritis can predict the development and the severity of anterior uveitis (AU) in oligoarticular juvenile idiopathic arthritis (JIA).

METHODS

In a retrospective study, a cohort of 366 patients with oligoarticular onset JIA from 3 pediatric rheumatology centers were evaluated. Patients were classified in 3 groups: severe uveitis (SU) with a mean >/= 2 uveitis relapses/year with complications or need for immunosuppressive therapy; mild uveitis (MU) with a mean </= 1 uveitis relapse/year with no complications; and no uveitis. Variables that were significant with univariate tests or were clinically relevant for each outcome underwent multivariate logistic regression analysis.

RESULTS

There were 316 patients available for analyses: 66 in the SU group, 64 in the MU group, and 186 in the no uveitis group. Multivariate analysis showed the following factors to be significant as predictors of AU onset: low age at onset (OR 0.96), a2-globulin plasma concentration (OR 1.34), and HLA-A19 (OR 2.87), B22 (OR 4.51) and DR9 (OR 2.33), while HLA-DR1 conferred protection (OR 0.13). This model was not good in predicting which patient would develop uveitis (sensitivity 55%, specificity 26%). Time interval between onset of arthritis and the first AU and elevated a2-globulin level in the serum were the best predictors of AU severity (OR 1.62 and 0.85, respectively). When applied prospectively, the model revealed good sensitivity (89.2%), specificity (76.1%), and efficiency (86.3%).

CONCLUSION

Clinical and laboratory variables measurable at onset of arthritis can be used to predict severity of the course of AU in oligoarticular JIA, but not its onset. More accurate prediction can shorten or lengthen the intervals between ophthalmologic evaluations and can change the therapeutic approach undertaken on the basis of expected disease severity.

Authors+Show Affiliations

Zulian F
Department of Pediatrics, University of Padua, Padua, Italy. zulian@pediatria.unipd.it
Martini G
No affiliation info available
Falcini F
No affiliation info available
Gerloni V
No affiliation info available
Zannin ME
No affiliation info available
Pinello L
No affiliation info available
Fantini F
No affiliation info available
Facchin P
No affiliation info available

MeSH

Age of OnsetArthritis, JuvenileChildChild, PreschoolCohort StudiesDisease ProgressionFemaleHumansInfantLogistic ModelsMaleMultivariate AnalysisPredictive Value of TestsRetrospective StudiesRisk FactorsSeverity of Illness IndexSurvival AnalysisUveitis

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12415607

Citation

Zulian, Francesco, et al. "Early Predictors of Severe Course of Uveitis in Oligoarticular Juvenile Idiopathic Arthritis." The Journal of Rheumatology, vol. 29, no. 11, 2002, pp. 2446-53.
Zulian F, Martini G, Falcini F, et al. Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol. 2002;29(11):2446-53.
Zulian, F., Martini, G., Falcini, F., Gerloni, V., Zannin, M. E., Pinello, L., Fantini, F., & Facchin, P. (2002). Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. The Journal of Rheumatology, 29(11), 2446-53.
Zulian F, et al. Early Predictors of Severe Course of Uveitis in Oligoarticular Juvenile Idiopathic Arthritis. J Rheumatol. 2002;29(11):2446-53. PubMed PMID: 12415607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. AU - Zulian,Francesco, AU - Martini,Giorgia, AU - Falcini,Fernanda, AU - Gerloni,Valeria, AU - Zannin,Maria Elisabetta, AU - Pinello,Luisa, AU - Fantini,Flavio, AU - Facchin,Paola, PY - 2002/11/5/pubmed PY - 2003/4/26/medline PY - 2002/11/5/entrez SP - 2446 EP - 53 JF - The Journal of rheumatology JO - J Rheumatol VL - 29 IS - 11 N2 - OBJECTIVE: To determine whether demographic, clinical, and laboratory variables at onset of arthritis can predict the development and the severity of anterior uveitis (AU) in oligoarticular juvenile idiopathic arthritis (JIA). METHODS: In a retrospective study, a cohort of 366 patients with oligoarticular onset JIA from 3 pediatric rheumatology centers were evaluated. Patients were classified in 3 groups: severe uveitis (SU) with a mean >/= 2 uveitis relapses/year with complications or need for immunosuppressive therapy; mild uveitis (MU) with a mean </= 1 uveitis relapse/year with no complications; and no uveitis. Variables that were significant with univariate tests or were clinically relevant for each outcome underwent multivariate logistic regression analysis. RESULTS: There were 316 patients available for analyses: 66 in the SU group, 64 in the MU group, and 186 in the no uveitis group. Multivariate analysis showed the following factors to be significant as predictors of AU onset: low age at onset (OR 0.96), a2-globulin plasma concentration (OR 1.34), and HLA-A19 (OR 2.87), B22 (OR 4.51) and DR9 (OR 2.33), while HLA-DR1 conferred protection (OR 0.13). This model was not good in predicting which patient would develop uveitis (sensitivity 55%, specificity 26%). Time interval between onset of arthritis and the first AU and elevated a2-globulin level in the serum were the best predictors of AU severity (OR 1.62 and 0.85, respectively). When applied prospectively, the model revealed good sensitivity (89.2%), specificity (76.1%), and efficiency (86.3%). CONCLUSION: Clinical and laboratory variables measurable at onset of arthritis can be used to predict severity of the course of AU in oligoarticular JIA, but not its onset. More accurate prediction can shorten or lengthen the intervals between ophthalmologic evaluations and can change the therapeutic approach undertaken on the basis of expected disease severity. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/12415607/Early_predictors_of_severe_course_of_uveitis_in_oligoarticular_juvenile_idiopathic_arthritis_ DB - PRIME DP - Unbound Medicine ER -