Characterization of JIA subtypes, clinical features, treatment patterns, and early outcomes in Palestinian children: a retrospective cohort study.

backgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease of childhood and includes a heterogeneous group of subtypes with varying clinical presentations, laboratory profiles, and outcomes. Data from the Middle East, including Palestine, remain limited. This study aimed to compare clinical characteristics, treatment patterns, and short-term outcomes between oligoarticular and non-oligoarticular JIA and to identify factors associated with disease subtype and six-month remission or relapse.

methodsA retrospective cohort study was conducted at pediatric rheumatology centers in Hebron, Palestine, including children diagnosed with JIA between January 2019 and August 2025. ILAR criteria were used for subtype classification. Demographic, clinical, laboratory, and treatment data were extracted from medical records. The primary outcome was remission or relapse at six months based on Wallace criteria. Statistical analyses included group comparisons and multivariable logistic regression to identify variables associated with subtype and relapse.

resultsA total of 171 children were included. Persistent oligoarticular JIA was the most common subtype (38.0%), followed by polyarticular RF-negative (PRF-) (22.8%) and enthesitis-related arthritis (ERA) (14.6%). Systemic JIA patients tended to have a younger age at onset and demonstrated a higher inflammatory burden. Knee arthritis was the most frequent joint involvement (63.7%), and extra-articular manifestations, particularly oral ulcers, rash, and uveitis, differed across subtypes. NSAIDs were used in 62.0% of patients, methotrexate in 79.5%, and biologics in 22.2%. After six months, 53.8% achieved remission while 46.2% relapsed, with systemic JIA and PRF- showing the highest relapse rates. Multivariable analysis showed that younger age, knee involvement, lower ESR, and six-month remission were independently associated with the oligoarticular subtype. Predictors of relapse included PRF- subtype, systemic JIA, and family history of rheumatologic disease.

conclusionThis study provides the first detailed characterization of JIA in Palestinian children, highlighting clinically meaningful differences between subtypes and identifying factors associated with remission and relapse. Systemic and PRF- JIA were linked to higher inflammatory activity and poorer short-term outcomes. These findings may support improved risk stratification and therapeutic planning and demonstrate the importance of long-term prospective studies in the region. CLINICAL TRIAL NUMBER: Not applicable.