Comorbidities emerge in adulthood for
many patients with JIA
By Michele G. Sullivan
More than half of young adults
with juvenile idiopathic arthritis
have comorbid conditions that impact their daily quality of life.
The issues range from directly
disease-related – like uveitis – to
more tangentially associated problems, like depression, Dr. Kirsten
Minden said at the congress.
“These comorbidities significantly impact the lives of young
patients with JIA but are under-rec-ognised and under-reported by
adult rheumatologists. Guidance
on risk assessment in adults with
JIA is needed,” said Dr. Minden of
the German Rheumatism Research
She discussed the findings
of two large German registries,
Biologika in der Kinder-Rheu-matologie (BiKeR) and Juvenile
Long-Term Observation (JUMBO).
Children enter BiKeR as soon as
they receive a JIA diagnosis; they
transfer to JuMBO when they turn
18 years old. Since 2001, 1,022 children have transitioned from the paediatric to young adult databases.
These patients are largely female
(68%), with a mean age of 23 years
and a mean disease duration of 13
years. Most (77%) had received at
least one biologic disease-modifying antirheumatic drug; the mean
number of those drugs received
was three. They were diagnosed
with a wide variety of JIA subtypes:
polyarthritis RF-negative (27%);
enthesitis-related (20%); extended
oligoarthritis (17%); polyarthritis
RF-positive (9%); psoriatic arthritis
(9%); persistent oligoarthritis (9%);
and systemic arthritis (5%). The remainder had other subtypes.
More than half of the patients
had at least one comorbidity; the
mean number of issues per patient
was two. Eye disorders were most
common (17%), with uveitis mak-
ing up 16% of that. Immune dis-
orders were also common (12%).
Psychiatric disorders occurred in
10%, with most of that (9%) being
depression. Another 9% had skin
or subcutaneous tissue disorders,
including psoriasis (3%).
Autoimmune thyroiditis occurred
in 2.5%, as did inflammatory bowel
disease. General gastrointestinal
disorders were present in 5%.
Men and women experienced
different comorbidity clusters.
Depression was more common
among women (12% vs. 3%), as
were pain disorders (6% vs. 2%)
and autoimmune disorders (3% vs.
1%). Men, however, experienced
more inflammatory bowel disease
than women (4% vs. 2%).
Comorbidities were also ex-
pressed differently among the
different JIA subtypes. Those with
systemic disease were more likely
to have hypertension (21%), oste-
oporosis (10%), and amyloidosis
(4%). Uveitis was most common
among those with extended ol-
igoarthritis (35%). Psoriasis was
most common among those with
psoriatic arthritis (20%).
A progressive enrollment assess-
ment showed some encouraging
trends, however. The patients
who enrolled in the earliest epoch
(2001-2005) were also oldest at
initial assessment ( 26). The ma-
jority of those (71%) had at least
one comorbidity. But from 2006-
2009, patients were younger when
assessed, and fewer had comor-
bidities (55%). In the last epoch of
2010-2016, patients were a mean of
20 when assessed, and about 45%
endorsed at least one comorbidity.
Hypertension, uveitis, and de-
pression have all decreased since
the first epoch, Dr. Minden noted.
Hypertension has gone down from
a rate of 21% in 2001-2005 to 13%
most recently. Depression declined
from 11.5% to 6%, and uveitis, from
17% to 2%.
This improvement, she said, may
reflect newer trends in earlier diag-
nosis, earlier treatment, and more
effective disease-modifying drugs.
“Age and disease duration do play
a role in the presence of comorbidities, but whether the lower rates are
due to younger age now is question-
able,” she said. “It may be that the
decreasing rates are due to earlier
and better treatment strategies, and
we are analysing this now.”
A key finding supports this hy-
pothesis, she noted.
“When we look at the presence
of short stature over time, we can
be encouraged about this. In the
earliest period, 5% had short stat-
ure. That is now seen in less than
1% of our patients enrolled in the
Dr. Minden is on the speak-
ers bureau of Pfizer, Roche, and
Pharm-Allergan. BiKeR is funded
by unconditional grants from Abb-
Vie, Germany, Novartis, Germany,
and Roche, Germany, JuMBO by
unconditional grants from AbbVie,
Pfizer, and Roche.
Dr. Kirsten Minden