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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

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
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