Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study

Donato Rigante, Alessandro Consolaro, Gabriella Giancane, Alessandra Alongi, Evert Hendrik Pieter Van Dijkhuizen, Amita Aggarwal, Sulaiman M Al-Mayouf, Francesca Bovis, Jaime De Inocencio, Erkan Demirkaya, Berit Flato, Dirk Foell, Stella Maris Garay, Călin Lazăr, Daniel J Lovell, Carolina Montobbio, Paivi Miettunen, Dimitrina Mihaylova, Susan Nielsen, Ilonka OrbanIngrida Rumba-Rozenfelde, Claudia Saad Magalhães, Nahid Shafaie, Gordana Susic, Maria Trachana, Nico Wulffraat, Angela Pistorio, Alberto Martini, Nicolino Ruperto, Angelo Ravelli, Reem Abdwani, Yahya Aghighi, Maya-Feriel Aiche, Constantin Ailioaie, Nuray Aktay Ayaz, Safiya Al-Abrawi, Ekaterina Alexeeva, Jordi Anton, Adriana Apostol, Olga Arguedas, Tadej Avcin, Patrizia Barone, Lillemor Berntson, Alina Lucica Boteanu, Yaryna Boyko, Ruben Burgos-Vargas, Inmaculada Calvo Penades, Gaëlle Chédeville, Rolando Cimaz, Adele Civino, Rita Consolini, Tamas Constantin, Ruben Cuttica, Tomas Dallos, Neil Martin, Silvia Magni Manzoni, Carmen De Cunto, Pavla Dolezalova, Maria Ekelund, Yasser El Miedany, Graciela Espada, Anne Estmann Christensen, Ivan Foeldvari, Romina Gallizzi, Gerd Ganser, Valeria Gerloni, Johannes-Peter Haas, Liora Harel, Miroslav Harjacek, Soad Hashad, Troels Herlin, Cristina Herrera, Michael Hofer, Dirk Holzinger, Gerd Horneff, Hans-Iko Huppertz, Nicolae Iagăru, Amparo Ibanez Estrella, Maka Ioseliani, Rik Joos, Sheila Knupp Oliveira, Sylvia Kamphuis, Ozgur Kasapcopur, Maria Martha Katsicas, Raju Khubchandani, Anuela Kondi, Liisa Kröger, Francesco La Torre, Matilda Laday, Pekka Lahdenne, Maria Cristina Maggio, Maria Greca Magnolia, Clara Malagon, Merja Malin, Silvana Martino, Jose Antonio Melo-Gomes, Pablo Mesa-Del-Castillo, Andrea Militaru, Kirsten Minden, Angela Miniaci, Mohammad Hasan Moradinejad, Zoilo Morel Ayala, Irina Nikishina, Ximena Norambuena, Ellen Berit Nordal, Karaman Pagava, Violeta Panaviene, Serena Pastore, Sara Pieropan, Rosa Anna Podda, Chris Pruunsild, Anne Putto-Laurila, Pierre Quartier, Agustin Remesal, Sarah Ringold, Lidia Rutkowska-Sak, Marite Rygg, Rotraud Katharina Saurenmann, Sujata Sawhney, Christiaan Scott, Reza Shiari, Elzbieta Smolewska, Betul Sozeri, Joost Frans Swart, Flavio Sztajnbok, Marta Torcoletti, Elena Tsitsami, Nikolay Tzaribachev, Erbil Unsal, Yosef Uziel, Paula Vähäsalo, Boriana Varbanova, Veronika Vargova, Richard Vesely, Gordana Vijatov-Djuric, Soamarat Vilaiyuk, Jelena Vojinovic, Olga Vougiouka, Pamela Weiss, Carine Wouters

Risultato della ricerca: Contributo in rivistaArticolo in rivista

25 Citazioni (Scopus)

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.
Lingua originaleEnglish
pagine (da-a)255-263
Numero di pagine9
RivistaTHE LANCET CHILD & ADOLESCENT HEALTH
Volume2019
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • Juvenile idiopathic arthritis

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