Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement: Results of a retrospective cohort study

Table 1 Comparative characteristics of patients with juvenile idiopathic arthritis with and without wrist arthritis

Parameters	Whole group, n = 753	Wrist arthritis, yes, n = 204	No wrist arthritis, n = 549	P value
Demography
Sex, females	457 (60.7)	149 (73.0)	308 (56.1)	0.00002
JIA onset age in years Me (25%-75%)	6.0 (3.0-10.4)	5.1 (2.8-9.4)	6.3 (3.0-10.7)	0.064
JIA duration in years Me (25%-75%)	4.3 (1.9-7.5)	5.3 (2.9-8.9)	3.7 (1.7-7.1)	0.00004
Age of the inclusion in the study, Me (25%-75%)	12.3 (7.9-16.5)	13.1 (8.7-17.0)	12.0 (7.4-16.3)	0.032
JIA category				0.000001
Oligoarthritis	204 (27.1)	12 (5.9)	192 (35.0)
Polyarthritis	265 (35.2)	119 (58.3)	146 (26.6)
Psoriatic arthritis	40 (5.3)	6 (2.9)	34 (6.2)
Enthesitis-related arthritis	186 (24.7)	33 (16.2)	153 (27.8)
Systemic arthritis	58 (7.7)	34 (16.7)	24 (4.4)
Uveitis	116 (15.4)	15 (7.4)	101 (18.4)	0.0002
Anthropometry
Height, %, Me (25%-75%)	137 (111-157)	43.1 (17.8-74.4)	56.1 (26.9-78.0)	0.022
Height, SD, Me (25%-75%)	0.11 (-0.7-0.8)	-0.15 (-1.0-0.7)	0.17 (-0.6. 0.9)	0.038
Weight in kg, Me (25%-75%)	31.5 (19.0-50.0)	28.0 (19.5-46.5)	33.0 (19.0-51.5)	0.385
Body mass index, SD, Me (25%-75%)	0.04 (-0.8-0.9)	-0.23 (-1.1-0.8)	0.09 (-0.7-0.9)	0.037
Laboratory
ANA-positivity	212/460 (46.1)	55/126 (43.7)	157/334 (47.1)	0.713
HLA B27-positivity	100/308 (32.5)	21/75 (28.0)	79/233 (33.9)	0.530
RF-positivity	22/406 (5.4)	7/118 (5.9)	15/288 (5.2)	0.377
ESR, mm/h, Me (25%-75%)	8.0 (3.0-20.0)	12.0 (5.0-29.5)	7.0 (3.0-17.0)	0.000002
C-reactive protein in mg/L, Me (25%-75%)	1.4 (0.2-8.0)	3.3 (0.2-19.5)	1.0 (0.0-6.0)	0.00003
White blood cells as × 109/L, Me (25%-75%)	7.1 (5.8-9.4)	7.4 (6.0-9.9)	7.0 (5.8-9.2)	0.056
Platelets as × 109/L, Me (25%-75%)	311 (255-388)	342 (278-433)	302 (253-373)	0.00006
Hemoglobin in g/L, Me (25%-75%)	124 (116-132)	121 (105-128)	126 (118-134)	0.000001
Joint involvement
Wrist arthritis, unilateral	204 (27,1)	83 (40.7)	-	-
Active joints, Me (25%-75%)	6 (3-12)	14 (8-25)	4 (2-8)	0.0000001
Cervical spine	101 (13.4)	62 (30.4)	39 (7.1)	0.0000001
TMJ	43 (5.7)	23 (11.3)	20 (3.6)	0.00006
SCJ	12 (1.6)	6 (2.9)	6 (1.1)	0.072
Shoulder	56 (7.4)	38 (18.6)	18 (3.3)	0.0000001
Elbow	120 (15.9)	74 (36.5)	46 (8.4)	0.000001
MCP	164 (21.8)	96 (47.1)	68 (12.4)	0.000001
PIP	192 (25.5)	109 (53.4)	83 (15.1)	0.000001
DIP	70 (9.3)	37 (18.1)	33 (6.0)	0.0000001
Hip	153 (20.3)	55 (27.0)	98 (17.9)	0.006
Hip osteoarthritis	48/153 (31.4)	24/55 (43.6)	24/98 (24.5)	0.014
Hip prosthetics	16/153 (10.5)	11/55 (20.0)	5/98 (5.3)	0.005
Time before hip osteoarthritis, Me (25%-75%)	5.0 (2.4-9.4)	5.7 (4.5-11.7)	2.3 (1.5-5.9)	0.0009
Sacroiliac	71 (9.4)	15 (7.4)	56 (10.2)	0.232
Knee	535 (72.8)	141 (69.1)	394 (71.9)	0.454
Ankle	323 (42.9)	122 (59.8)	201 (36.6)	0.0000001
Subtalar	62 (8.2)	21 (10.3)	41 (7.5)	0.210
Tarsus	43 (5.7)	20 (9.8)	23 (4.2)	0.003
MTP	98 (13.0)	31 (15.2)	67 (12.2)	0.278
Interphalangeal foot	94 (12.8)	31 (15.2)	63 (11.5)	0.170
Treatment and outcomes
NSAID	651 (86.5)	172 (84.3)	479 (87.3)	0.295
Any joints IACI	314 (41.7)	77 (37.8)	237 (43.2)	0.180
Oral GCS	152 (20.2)	78 (38.2)	74 (13.5)	0.0000001
GCS pulse therapy	135 (17.9)	67 (33.0)	68 (12.4)	0.0000001
Any GCS treatment	445 (59.1)	142 (69.6)	303 (55.2)	0.0003
Cumulative dose of GCS in mg, Me (25%-75%)	2650 (1000-5000)	3000 (1000-6000)	1750 (900-4000)	0.048
Methotrexate	573 (76.1)	174 (85.3)	399 (72.7)	0.0003
Sulphasalazine	137 (18.2)	28 (13.7)	109 (19.9)	0.053
Leflunomide	7 (9.2)	6 (2.9)	1 (0.2)	0.0005
Cyclosporine A	53 (7.0)	26 (12.8)	27 (4.9)	0.0002
Biologics	351 (46.6)	125 (61.3)	226 (41.2)	0.000001
Time before biologics in years, Me (25%-75%)	4.2 (1,9-7.8)	3.9 (1.5-8.0)	4.3 (2.0-7.6)	0.464
Remission	485 (64.4)	118 (57.8)	367 (66.9)	0.022
Time before remission in years, Me (25%-75%)	3.2 (1.5-6.6)	4.1 (1.8-7.9)	3.0 (1.4-6.1)	0.002
Flare	138 (18.3)	28 (13.7)	110 (20.1)	0.046

Data are n (%). ANA: Antinuclear antibodies; DIP: Distal interphalangeal joints; ESR: Erythrocyte sedimentation rate; GCS: Glucocorticosteroids; JIA: Juvenile idiopathic arthritis; IACI: Intraarticular joint injections; Me: Median; MCP: Metacarpophalangeal joints; MTP: Metatarsophalangeal joints; NSAIDs: Nonsteroid anti-inflammatory drugs; PIP: Proximal interphalangeal joints; RF: Rheumatoid factor; SCJ: Sternoclavicular joint; TMJ: Temporomandibular joint.

Table 2 Factors associated with wrist involvement in juvenile idiopathic arthritis patients

Parameter	Se	Sp	OR (95%CI)	P value
Sex, female	43.9	73.0	2.1 (1.5-3.0)	0.00002
Systemic JIA	16.7	95.6	4.4 (2.5-7.6)	0.0000001
Uveitis	89.1	26.4	0.43 (0.21-0.91)	0.0002
Active joints > 9	69.6	81.1	9.8 (6.8-14.1)	0.000001
Height ≤ 39%	47.1	65.0	1.7 (1.1-2.5)	0.011
BMI ≤ -0.3 SD	49.7	64.1	1.8 (1.2-2.6)	0.004
CRP > 5.9 mg/L	41.0	76.0	2.2 (1.5-3.1)	0.00001
ESR > 11 mm/h	50.5	67.1	2.1 (1.5-2.9)	0.00002
Platelets > 292 × 109/L	71.9	46.6	2.2 (1.5-3.1)	0.00001
Cervical spine	30.4	92.9	5.7 (3.7-8.9)	0.0000001
TMJ involvement	11.3	96.4	3.2 (1.7-6.0)	0.00006
Shoulder involvement	18.6	96.7	4.1 (2.3-7.4)	0.0000001
Elbow involvement	36.5	91.6	6.3 (4.1-9.5)	0.000001
MCP involvement	47.1	87.6	6.3 (4.3-9.1)	0.000001
PIP involvement	53.4	84.9	6.7 (4.6-9.5)	0.000001
DIP involvement	18.1	94.0	3.5 (2.1-5.7)	0.0000001
Hip involvement	27.0	83.4	1.7 (1.2-2.5)	0.006
Hip osteoarthritis involvement	43.6	75.5	2.4 (1.2-4.8)	0.014
Hip prosthetics involvement	20.0	94.8	4.7 (1.5-14.2)	0.005
Time before hip osteoarthritis > 3.2 years	95.7	57.1	29.3 (3.3-260.1)	0.0001
Ankle involvement	59.8	63.4	2.6 (1.9-3.6)	0.0000001
Tarsus involvement	9.8	95.8	2.5 (1.3-4.6)	0.003
Treatment with oral GCS	38.2	86.5	4.0 (2.7-5.8)	0.0000001
GCS pulse therapy	33.0	87.5	3.5 (2.4-5.1)	0.0000001
Any GCS treatment	69.6	44.8	3.6 (2.6-5.0)	0.0003
Methotrexate	91.6	16.4	6.7 (3.9-11.5)	0.0003
Biologics	61.3	58.8	2.3 (1.6-3.1)	0.000001
No remission	42.2	66.8	1.5 (1.1-2.0)	0.022
Time before remission > 3.1 years	61.0	53.3	1.8 (1.3-2.5)	0.0006
No flare	86.3	20.1	1.6 (1.01-2.5)	0.046

Data are n (%). BMI: Body mass index; CRP: C-reactive protein; DIP: Distal interphalangeal joints; ESR: Erythrocyte sedimentation rate; GCS: Glucocorticosteroids; JIA: Juvenile idiopathic arthritis; MCP: Metacarpophalangeal joints; PIP: Proximal interphalangeal joints.

Table 3 Comparative characteristics of patients with juvenile idiopathic arthritis with unilateral or bilateral wrist involvement

Parameters	Unilateral, n = 83	Bilateral, n = 121	P value
Demography
Sex, female	65 (78.3)	84 (69.4)	0.160
JIA onset age in years Me (25%-75%)	5.4 (2.9-10.0)	5.0 (2.8-8.9)	0.578
JIA duration in years Me (25%-75%)	4.8 (2.5-7.9)	5.9 (3.0-10.0)	0.231
Age of the inclusion in the study in years, Me (25%-75%)	11.7 (8.4-17.3)	13.7 (8.8-17.0)	0.368
Uveitis	9 (10.8)	6 (5.0)	0.114
Laboratory
ANA-positivity	31/54 (57.4)	24/72 (33.3)	0.031
HLA B27-positivity	11/33 (33.3)	10/42 (23.8)	0.362
RF-positivity	2/50 (4.0)	5/68 (7.4)	0.720
ESR in mm/h, Me (25%-75%)	11.0 (4.0-30.0)	12.5 (5.0-26.0)	0.746
C-reactive protein in mg/L, Me (25%-75%)	1.5 (0.2-11.6)	4.4 (0.4-36.0)	0.027
White blood cells as × 109/L, Me (25%-75%)	7.4 (6.1-9.4)	7.5 (6.0-10.6)	0.416
Platelets as × 109/L, Me (25%-75%)	345 (291-419)	335 (263-448)	0.905
Hemoglobin in g/L, Me (25%-75%)	121 (107-128)	121 (105-129)	0.880
Joint involvement
Active joints, Me (25%-75%)	9 (6-13)	23 (12-34)	0.0000001
Cervical spine	12 (14.5)	50 (41.3)	0.00004
TMJ	4 (4.8)	19 (15.7)	0.016
SCJ	2 (2.4)	4 (3.3)	0.710
Shoulder	5 (6.0)	33 (27.3)	0.0001
Elbow	14 (17.1)	60 (49.6)	0.000002
MCP	29 (34.9)	67 (55.4)	0.004
PIP	36 (43.4)	73 (60.3)	0.017
DIP	10 (12.1)	27 (22.3)	0.062
Hip	12 (14.5)	43 (35.5)	0.0009
Hip osteoarthritis	4/12 (33.3)	9/43 (20.9)	0.371
Hip prosthetics	2/12 (16.7)	9/43 (20.9)	0.744
Time before hip osteoarthritis, Me (25%-75%)	8.2 (4.4-11.7)	5.2 (4.7-10.2)	0.972
Sacroiliac	5 (6.0)	10 (8.3)	0.547
Knee	43 (51.8)	98 (81)	0.000009
Ankle	33 (39.8)	89 (73.6)	0.000001
Subtalar	4 (4.8)	17 (14.1)	0.033
Tarsus	4 (4.8)	16 (13.2)	0.047
MTP	10 (12.1)	21 (17.4)	0.300
Interphalangeal foot	11 (13.3)	20 (16.5)	0.522
Treatment and outcomes
NSAID	72 (86.8)	100 (82.6)	0.429
Any joints IACI	42 (50.6)	35 (28.9)	0.002
Oral GCS	23 (27.7)	55 (45.5)	0.010
GCS pulse therapy	23 (27.7)	44 (36.4)	0.182
Any GCS treatment	60 (40.7)	82 (59.3)	0.490
Cumulative dose of GCS in mg, Me (25%-75%)	3000 (1000-6000)	3000 (1135-5625)	0.668
Methotrexate	72 (92.8)	102 (84.3)	0.628
Sulphasalazine	12 (14.5)	16 (13.2)	0.801
Leflunomide	1 (1.2)	5 (4.1)	0.235
Cyclosporine A	5 (6.0)	21 (17.4)	0.017
Biologics	41 (49.4)	84 (69.4)	0.004
Time before biologics in years, Me (25%-75%)	5.0 (1.8-8.2)	3.67 (1.1-7.7)	0.187
Remission	48 (57.8)	70 (57.9)	0.998
Time before remission in years, Me (25%-75%)	3.8 (1.8-7.4)	4.2 (1.7-8.6)	0.471
Flare	11 (13.3)	17 (14.1)	0.871

Data are n (%). ANA: Antinuclear antibodies; DIP: Distal interphalangeal joints; ESR: Erythrocyte sedimentation rate; GCS: Glucocorticosteroids; JIA: Juvenile idiopathic arthritis; Me: Median; MCP: Metacarpophalangeal joints; MTP: Metatarsophalangeal joints; NSAIDs: Nonsteroid anti-inflammatory drugs; PIP: Proximal interphalangeal joints; RF: Rheumatoid factor; SCJ: Sternoclavicular joint; TMJ: Temporomandibular joint.