Disease Activity States of Juvenile Idiopathic Arthritis in a Referral Centre in Bangladesh

Abstract

Background: The clinical course of juvenile idiopathic arthritis (JIA) is unpredictable and characterised by periods of disease inactivity followed by active disease states with on or off medication. Objectives: To assess the disease activity state of JIA patients in our centre and compare them with other available reports. Methods: A retrospective cohort study carried out in the department of paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2010 to December 2019 . A total of 1782 JIA patients, fulfilling ILAR criteria, who have completed at least three years of follow-up were enrolled in this study. Disease activity states were assessed according to Wallace’s criteria. Results: The mean age at presentation of disease was 8.33±4.8 years and M:F ratio was 1.4:1. Enthesitis related arthritis (ERA) was the commonest (38.0%) subtype, followed by systemic arthritis and RF–ve polyarthritis. Eighty-three percent of the JIA patients were treated with MTX followed by sulfasalazine (30.0%) and leflunamide (13.0%). Only 12.0% received biological agents and other drugs including thalidomide and tofacitinib. At 3 years follow-up, 39.2% had active disease and 60.7% had non-active disease states. Inactive disease states, clinical remission on medication (CRM) and clinical remission off medication (CR) were maintained by 27.1%, 20.1 %, and 13.3% of JIA patients respectively. Conclusion: Most (60.7%) of the JIA patients maintained CRM, CR and inactive disease states. Active disease was found in 39.2% of JIA patients. The highest rate of remission was achieved in persistent oligoarthritis cases. RF+ve polyarthritis patients had the lowest remission rate. Bangladesh Med Res Counc Bull 2022; 48(1): 41-47