Age at diagnosis as a prognostic factor in selected categories of juvenile idiopathic arthritis.

introductionThe age at the onset of juvenile idiopathic arthritis (JIA) can influence the trajectory of the disease. We aimed to clarify how age at the visit 6 months after the onset as a continuous variable affects long-term remission of JIA.

methodsThis study investigated 358 patients from the Nordic JIA cohort study. Age at diagnosis was analysed continuously. Three age groups were studied: under 3 years, 3-5 years and over 6 years of age. JIA was categorised as oligoarthritis, seronegative polyarthritis and others (enthesitis-related, psoriatic and undifferentiated arthritis). Clinical data, collected at 6 months after the onset of symptoms, included information about disease activity, uveitis, laboratory test values and medication. The outcomes assessed 17.5 years after diagnosis included remission, health-related quality of life (HRQoL), and functional ability.

resultsThe majority of patients with oligoarthritis and polyarthritis were diagnosed before age six, compared with 29% in the group of others. In the oligoarthritis group, predictors of remission included age at diagnosis, male gender, the Juvenile Arthritis Disease Activity Score-71 (JADAS71) and the absence of uveitis. In seronegative polyarthritis, predictors of remission were age at diagnosis and JADAS71 score. In the oligoarthritis group, remission rates were highest in both genders when diagnosed <3 years of age. In the seronegative polyarthritis group, this was not true for female patients. Age at diagnosis had no significant effect on HRQoL or functional ability.

conclusionsAge at diagnosis in the oligoarthritis was inversely and in the seronegative polyarthritis positively associated with long-term remission in JIA, primarily in females.