Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Phenotypic Variability and Disparities in Treatment and Outcomes of Childhood Arthritis Throughout the World: An Observational Cohort Study Publisher Pubmed



Consolaro A1, 5 ; Giancane G1 ; Alongi A1 ; Van Dijkhuizen EHP1, 6 ; Aggarwal A7 ; Almayouf SM9 ; Bovis F1, 4 ; De Inocencio J8 ; Demirkaya E10 ; Flato B11, 12 ; Foell D13 ; Garay SM14 ; Lazar C15 ; Lovell DJ16 Show All Authors
Authors
  1. Consolaro A1, 5
  2. Giancane G1
  3. Alongi A1
  4. Van Dijkhuizen EHP1, 6
  5. Aggarwal A7
  6. Almayouf SM9
  7. Bovis F1, 4
  8. De Inocencio J8
  9. Demirkaya E10
  10. Flato B11, 12
  11. Foell D13
  12. Garay SM14
  13. Lazar C15
  14. Lovell DJ16
  15. Montobbio C1
  16. Miettunen P17
  17. Mihaylova D18
  18. Nielsen S19
  19. Orban I20
  20. Rumbarozenfelde I21
  21. Magalhaes CS22
  22. Shafaie N23
  23. Susic G24
  24. Trachana M25
  25. Wulffraat N6
  26. Pistorio A2
  27. Martini A1, 3, 5
  28. Ruperto N1, 4
  29. Ravelli A1, 5
Show Affiliations
Authors Affiliations
  1. 1. Clinic of Paediatrics and Rheumatology, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
  2. 2. Epidemiology and Biostatistics Service, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
  3. 3. Scientific Directory, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
  4. 4. PRINTO, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
  5. 5. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Sciences, University of Genoa, Genoa, Italy
  6. 6. Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, Netherlands
  7. 7. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  8. 8. Department of Pediatric Rheumatology, University Hospital 12 de Octubre, Madrid, Spain
  9. 9. Department of Pediatric Rheumatology, King Faisal Specialist Hospital & Research Center, Alfaisal University, Riyadh, Saudi Arabia
  10. 10. London Health Sciences Centre, Western University Children's Hospital, London, ON, Canada
  11. 11. Department of Rheumatology and Medical Faculty, Oslo University Hospital and University of Oslo, Oslo, Norway
  12. 12. Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
  13. 13. Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
  14. 14. Rheumatology Service, Hospital Sor Maria Ludovica, La Plata, Argentina
  15. 15. Bucharest Emergency Hospital and Children's Emergency Hospital, Cluj-Napoca, Romania
  16. 16. Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
  17. 17. Division of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada
  18. 18. Pediatric Department, Sofiamed, Sofia, Bulgaria
  19. 19. Paediatric Rheumatology Unit, Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
  20. 20. Clinical Immunology, Adult and Paediatric Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  21. 21. Pediatric Department, Latvia and University Children's Hospital, University of Latvia, Riga, Latvia
  22. 22. Botucatu Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
  23. 23. Rheumatology Research Center, Department of Pediatrics and Rheumatology, Shariati Hospital, Teheran, Iran
  24. 24. Division of Pediatric Rheumatology, Institute of Rheumatology of Belgrade, Belgrade, Serbia
  25. 25. First Department of Pediatrics, Hippokration General Hospital, Thessaloniki University School of Medicine, Thessaloniki, Greece

Source: The Lancet Child and Adolescent Health Published:2019


Abstract

Background: To our knowledge, the characteristics and burden of childhood arthritis have never been studied on a worldwide basis. We aimed to investigate, with a cross-sectional study, the prevalence of disease categories, treatment methods, and disease status in patients from across different geographical areas and from countries with diverse wealth status. Methods: In this multinational, cross-sectional, observational cohort study, we asked international paediatric rheumatologists from specialised centres to enrol children with a diagnosis of juvenile idiopathic arthritis, according to International League of Associations for Rheumatology criteria, who were seen consecutively for a period of 6 months. Each patient underwent retrospective and cross-sectional assessments, including measures of disease activity and damage and questionnaires on the wellbeing and quality of life of the children. We qualitatively compared the collected data across eight geographical areas, and we explored an association between disease activity and damage and a country's gross domestic product (GDP) with a multiple logistic regression analysis. Findings: Between April 4, 2011, and Nov 21, 2016, 9081 patients were enrolled at 130 centres in 49 countries, grouped into eight geographical areas. Systemic arthritis (125 [33·0%] of 379 patients) and enthesitis-related arthritis (113 [29·8%] of 379) were more common in southeast Asia, whereas oligoarthritis was more prevalent in southern Europe (1360 [56·7%] of 2400) and rheumatoid factor-negative polyarthritis was more frequent in North America (165 [31·5%] of 523) than in the other areas. Prevalence of uveitis was highest in northern Europe (161 [19·1%] of 845 patients) and southern Europe (450 [18·8%] of 2400) and lowest in Latin America (54 [6·4%] of 849), Africa and Middle East (71 [5·9%] of 1209), and southeast Asia (19 [5·0%] of 379). Median age at disease onset was lower in southern Europe (3·5 years, IQR 1·9–7·3) than in other regions. Biological, disease-modifying antirheumatic drugs were prescribed more frequently in northern Europe and North America than in other geographical settings. Patients living in countries with lower GDP had greater disease activity and damage than those living in wealthier countries. Damage was associated with referral delay. Interpretation: Our study documents a variability in prevalence of disease phenotypes and disparities in therapeutic choices and outcomes across geographical areas and wealth status of countries. The greater disease burden in lower-resource settings highlights the need for public health efforts aimed at improving equity in access to effective treatments and care for juvenile idiopathic arthritis. Funding: IRCCS Istituto Giannina Gaslini. © 2019 Elsevier Ltd
Related Docs
1. Development and Initial Validation of Parent and Child Versions of the Juvenile Arthritis Disease Activity Score, Rheumatology (2025)
2. Autoimmune Diseases, Clinical Immunology (2022)
3. Changes of Platelet Indices in Juvenile Idiopathic Arthritis in Acute Phase and After Two Months Treatment, Iranian Journal of Pediatrics (2016)
4. Lack of Association Between Stat4 Single Nucleotide Polymorphisms and Iranian Juvenile Rheumatoid Arthritis Patients, Fetal and Pediatric Pathology (2017)
5. Macrophage Activation Syndrome As a Complication of Rheumatologic Disorders, a Report From Iran, Reumatismo (2019)
6. The Farsi Version of the Juvenile Arthritis Multidimensional Assessment Report (Jamar), Rheumatology International (2018)
7. Association of Interferon Regulatory Factor 5 (Irf5) Gene Polymorphisms With Juvenile Idiopathic Arthritis, Clinical Rheumatology (2018)
8. Dynamic Changes, Cut-Off Points, Sensitivity, and Specificity of Laboratory Data to Differentiate Macrophage Activation Syndrome From Active Disease, Disease Markers (2015)
Experts (# of related papers)
View all Related Experts
Vahid Ziaee (6)
Nima Rezaei (3)