The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia

Epidemiology and demographics of juvenile idiopathic arthritis in Africa and Middle East

Juvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA.

Temporomandibular joint involvement in children with juvenile idiopathic arthritis: A single tertiary-center experience

OBJECTIVES

To describe the clinical and laboratory characteristic, state the treatment and outcome of patients with juvenile idiopathic arthritis (JIA), and describe temporomandibular joint (TMJ) involvement as observed in a large tertiary center.

METHODS

A retrospective cross-sectional study of children diagnosed with JIA was assessed at King Abdullah Specialist Children's Hospital, Riyadh, Saudi Arabia (2015-2019), which included a descriptive analysis of children who had TMJ involvement among our study group. Subjects diagnosed with the TMJ arthritis were based either on clinical musculoskeletal examination or using contrast-enhanced MRI.

RESULTS

We reviewed 123 cases with different JIA subtypes (57% females). The most frequent subtype is the oligoarticular (36%). TMJ involvement was found in 16% (n=20/123) of the patients, of whom 45% had Polyarticular JIA. The rheumatoid factor was positive in 25%; antinuclear antibody (ANA) in 45% and none showed positivity to HLAB27. Treatment resulted in complete resolution in 95% of cases, while Micrognathia and obstructive sleep apnea were the complications reported in 5% of cases.

CONCLUSION

TMJ involvement in JIA is not uncommon. Females with polyarticular disease were more frequently affected with TMJ arthritis. Positive ANA could be a risk factor for TMJ involvement, while positive HLAB27 might have some protective effects. Early treatment for TMJ arthritis is essential to avoid possible complications.

Juvenile idiopathic arthritis in Jordan: single center experience

BACKGROUND

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders, including all forms of arthritis, which develops in children who are less than 16 years old. This study aimed to evaluate the clinical and laboratory features of JIA in a single center in Jordan.

METHODS

A retrospective analysis of the electronic medical records of Pediatric patients diagnosed with JIA based on the International League of Associations for Rheumatology (ILAR) criteria during the period from 2015 to 2019 at the Pediatric Rheumatology Clinic in the Queen Rania Children's Hospital. All patients were below the age of 14 years at the time of diagnosis and followed for at least 6 months. Collected data consisted of age, gender, age at initial presentation and diagnosis, JIA subtype, laboratory data, treatment options, and outcome.

RESULTS

A total of 210 patients were included in this cohort (94 males and 116 females) with the mean age at diagnosis and mean age at onset of 5.33 ± 3.40 years and 5.08 ± 3.40 years (range: 7 months - 14 years), respectively. Oligoarticular JIA was the commonest subtype (54.7%), followed by systemic arthritis (17.1%) and polyarticular arthritis (12.3%). ANA was positive in 70 patients (33.6%). Uveitis occurred in 30 (14.2%) patients.

CONCLUSION

To the best of our knowledge, this study on this cohort is the first report on JIA in Jordan, in comparison with other regionally and internationally published reports. Oligoarticular JIA was found to be the most common subtype. For detailed knowledge on JIA characteristics and patterns, a population-based, rather than a single center study, should be conducted in Jordan.

Methotrexate Hepatotoxicity in Children with Juvenile Idiopathic Arthritis: A Single-Center Study

BACKGROUND

Juvenile idiopathic arthritis (JIA) could be disabling if left untreated. Methotrexate (MTX) is well known as a cornerstone in management. However, its adverse effects may limit treatment.

OBJECTIVE

The objective of this study was to evaluate the frequency of hepatotoxicity based on liver chemistry in JIA children receiving MTX.

METHODS

An observational case-control study of children with JIA who attend the Pediatric Rheumatology Unit, Cairo University Pediatric Hospital, Egypt, from January 2018 to December 2018 was carried out. Data were retrieved for 80 children; 50 (62.5%) were prescribed MTX. Their demographic, clinical characteristics, mean dose, duration of MTX therapy and other medications were described. Hepatotoxicity was defined as at least one value above the normal laboratory range of either ALT or AST during the study period.

RESULTS

Fourteen patients developed hepatotoxicity, giving an incidence of 28%. Children receiving MTX had higher alanine aminotransferase (ALT) interquartile range (IQR) (26 [21-359] vs. 23[20-32]; p =0.003), higher aspartate aminotransferase (AST) interquartile range (IQR) (31 [22-267] vs. 28[2-35] IU/L; p <0.001), and lower alkaline phosphatase (ALP) mean (±SD) (98±35.5 vs. 256 ± 39.5 IU/L; p <0.001). However, there were no significant differences in age, sex, weight, type of JIA, and duration of MTX treatment (p< 0.05).

CONCLUSION

Hepatotoxicity due to MTX, based on liver chemistry, is common among children with JIA.

Surgical outcomes of open hip reduction with synovectomy for developmental dysplasia of the hip patient with Juvenile idiopathic arthritis: A case report

INTRODUCTION

Developmental dysplasia of the hip (DDH) is a common hip disorder and its association with other musculoskeletal, genetic, and neurological diseases were well described in the literature. Juvenile idiopathic arthritis (JIA) is a rare rheumatological condition, and its presence in a Developmental dysplasia of the hip (DDH) child makes this a very challenging case.

PRESENTATION OF THE CASE

This case report is describing the presentation of 9 months old girl to orthopedic service referred from the pediatric rheumatology clinic after diagnosing her and starting the treatment for Juvenile idiopathic arthritis (JIA). Bilateral neglected Developmental dysplasia of the hip (DDH) - International Hip Dysplasia Institute (IHDI) type 4- was detected during her clinical and radiological assessment, necessitating surgical management after controlling her Juvenile idiopathic arthritis (JIA). The surgical procedure and its clinical and radiological outcomes more than four years after her surgical treatment are described in detail in this report as well.

DISCUSSION

The management of Developmental dysplasia of the hip (DDH) associated with Juvenile idiopathic arthritis (JIA) has no established guidelines in literature. Here, we share our experience in managing such rare cases. We believe that medical control of Juvenile idiopathic arthritis (JIA) before proceeding for open reduction of Developmental dysplasia of the hip (DDH) is the key to successful results.

CONCLUSION

The reported case is uniquely having both Developmental dysplasia of the hip (DDH) and Juvenile idiopathic arthritis (JIA) treated with open reduction, pelvic osteotomy, and femoral shortening resulting in outstanding clinical and radiological outcomes.

Dynamics of concomitant therapy in children with juvenile idiopathic arthritis treated with etanercept and methotrexate

BACKGROUND

Both the steroid- and NSAID-sparing effects of biologics in juvenile idiopathic arthritis (JIA) treatment are key aspects of the dynamics of patient's condition. The proper selection of biologics enables maximum treatment effectiveness and reduction of the dosage of concomitant therapy. Our aim was to study the dynamics of concomitant therapy during etanercept (ETA) and methotrexate (MTX) treatment in patients with JIA.

METHODS

This analysis included 215 JIA patients (63.3% females) showing sufficient response to main therapy. One hundred patients received MTX as main therapy, 24 received ETA monotherapy, and 91 received ETA þ MTX combination therapy. The dynamics of concomitant therapy were analyzed after 1 month, every 3 months during the first year, and every 6 months during the long-term follow-up (up to 5 years).

RESULTS

At the baseline, 24 (11.2%) patients received concomitant oral glucocorticoids (orGCs) and NSAIDs; the remaining 191 (88.8%) patients were treated with concomitant NSAIDs only. Within 1-year treatment, NSAIDs were discontinued in 162 (75.3%) patients. There were no significant differences in the dynamics of withdrawal of NSAIDs in patients who received and did not receive concomitant MTX. However, the percentage of treatment discontinuation in the MTX group was significantly lower compared to the other two groups (p < 0.001). Oral GCs were discontinued completely in 4 children (16.7%), and the dose of oral GCs was reduced in another 4 patients (16.7%). By the end of the follow-up period, 44 of 115 patients (38.3%) treated with ETA in combination with any concomitant therapy could switch to ETA monotherapy.

CONCLUSION

Therapy with ETA makes it possible to reduce the dosage or completely discontinue most concomitant medications (orGCs, NSAIDs, MTX) in a significant percentage of patients. This reduces the risk of development of NSAID- and GC-induced pathological conditions, while the effectiveness of therapy of the underlying condition remains high.