Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 9, 2024; 13(3): 91656
Published online Sep 9, 2024. doi: 10.5409/wjcp.v13.i3.91656
Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement: Results of a retrospective cohort study
Lyubov Sorokina, Maria Kaneva, Artem Artamonov, Natalia Gordeeva, Irina Chikova, Mikhail Kostik
Lyubov Sorokina, Maria Kaneva, Artem Artamonov, Irina Chikova, Mikhail Kostik, Hospital Pediatry, Saint Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Natalia Gordeeva, Department of Consulting and Diagnostic, Saint-Petersburg Children’s Hospital #2, n.a. Saint Mary Magdalene, Saint Petersburg 199004, Russia
Mikhail Kostik, Research Laboratory of Autoimmune and Autoinflammatory Diseases, Almazov National Medical Research Center, Saint-Petersburg 197341, Russia
Author contributions: Kostik MM and Sorokina LS contributed to conceptualization, writing—review and editing; Kostik MM and Chikova IA contributed to methodology; Artamonov AK contributed to software, resources, and data curation; Artamonov AK, Kaneva MA, and Gordeeva NA contributed to validation; Sorokina LS contributed to formal analysis; Kaneva MA contributed to investigation and visualization; Kostik MM contributed to writing—original draft preparation, funding, supervision, and project administration; All authors have read and agreed to the published version of the manuscript.
Supported by Ministry of Science and Higher Education of the Russian Federation, No. 075-15-2022-301.
Institutional review board statement: The protocol of the study was approved by the local Ethical Committee of Saint Petersburg State Pediatric Medical University (#11/10 from 23.11.2020).
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mikhail Kostik, MD, PhD, Professor, Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg 194100, Russia. kost-mikhail@yandex.ru
Received: January 1, 2024
Revised: June 16, 2024
Accepted: June 26, 2024
Published online: September 9, 2024
Processing time: 241 Days and 11.1 Hours
Abstract
BACKGROUND

Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis (JIA) with progressive disease course, polyarticular involvement and failure of methotrexate treatment.

AIM

To describe features of JIA, associated with wrist arthritis.

METHODS

Data from about 753 JIA patients were included in this retrospective cohort study. The clinical and laboratory features of patients with and without wrist involvement were analyzed.

RESULTS

Wrist involvement was found in oligoarthritis (5.8%), RF(−)/RF(+) polyarthritis (44.9%/15.0%), enthesitis-related arthritis (17.7%), and systemic (58.6%) JIA categories. Unilateral wrist involvement was typical for oligoarthritis patients, bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories. Wrist arthritis was found to be associated with female sex, a low incidence of uveitis, and more indications of systemic inflammation, including elevated levels of C-reactive protein, erythrocyte sedimentation rate, and platelets, as well as involvement of the cervical spine, temporomandibular, shoulder, elbow, metacarpophalangeal, proximal interphalangeal, distal interphalangeal, hip, ankle, and tarsus arthritis. The number of patients with hip osteoarthritis and hip replacement was also higher. Wrist arthritis was associated with a lower probability of achieving remission [hazard ratio (HR) = 1.3 (95%CI: 1.0-1.7), P = 0.055], and a higher probability of being treated with biologics [HR = 1.7 (95%CI: 1.3-2.10, P = 0.00009)].

CONCLUSION

Wrist arthritis in JIA patients is a marker of a severe disease course, characterized by more intensive inflammation, unfavorable outcomes, and. requiring more intensive treatment with early administration of biologics. Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.

Keywords: Wrist; Hand; Juvenile idiopathic arthritis; Outcomes; Biologics; Methotrexate

Core Tip: Wrist arthritis has specific symptoms, such as muscle weakness, paresthesia, limited fist function, limited pinch grip, joint deviation, aesthetic complaints, and difficulties in writing, drawing, and working with a knife, pencil, laptop, or other device. The frequency of wrist involvement in juvenile idiopathic arthritis categories was 5.8% in oligoarthritis, 44.9% in RF(−), 15.0% in RF( +) polyarthritis, 17.7% in enthesytis-related arthritis, and 58.6% in systemic. Wrist arthritis was associated with higher inflammation, specific joint involvement (cervical spine, temporomandibular, shoulder, elbow, metacarpophalangeal, proximal interphalangeal, distal interphalangeal, hip, ankle, and tarsus), a lower probability of achieving remission, and a higher probability of being treated with biologics.