RESEARCH - Patients with ANA-positive juvenile idiopathic arthritis constitute a homogenous subgroup

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Arthritis Rheum. 2005 Mar;52(3):826-32.

Patients with antinuclear antibody-positive juvenile idiopathic arthritis

constitute a homogeneous subgroup irrespective of the course of joint

disease.

Ravelli A, Felici E, Magni-Manzoni S, Pistorio A, Novarini C, Bozzola E,

Viola S, i A.

IRCCS G. Gaslini, Genoa, Italy. angelorav

<angelorav>

OBJECTIVE: We recently hypothesized that in the International League of

Associations for Rheumatology (ILAR) classification of juvenile idiopathic

arthritis (JIA), the presumably homogeneous patient group characterized by

early onset of disease, a female predilection, the presence of antinuclear

antibodies (ANA), asymmetric arthritis, and the risk for iridocyclitis is

classified into different categories. We sought to investigate whether

ANA-positive patients belonging to the ILAR categories of oligoarthritis and

rheumatoid factor (RF)-negative polyarthritis share homogeneous features and

to compare these features with those of ANA-negative patients with JIA in

the same categories.

METHODS: We identified patients who were followed up

during a 15-year period. All patients had JIA according to the ILAR

criteria, with oligoarticular or polyarticular onset. ANA positivity was

defined as 2 or more positive results at a titer of >or=1:160. Demographic

and clinical features, including the number of joints involved over time and

measures of JIA severity at the last followup visit, were recorded

retrospectively.

RESULTS: A total of 256 patients were included: 190 were

ANA positive (109 had persistent oligoarthritis, 48 had extended

oligoarthritis, and 33 had RF-negative polyarthritis), and 66 were ANA

negative (35 had RF-negative polyarthritis, and 31 had oligoarthritis). All

patients who were positive for ANA were similar in terms of age at disease

presentation, female-to-male ratio, and frequency of symmetric arthritis and

iridocyclitis. Compared with ANA-positive patients with polyarticular

disease, ANA-negative patients with polyarticular arthritis were older at

disease presentation and had a lower frequency of iridocyclitis, a higher

frequency of symmetric arthritis, a greater cumulative number of joints

affected over time, and a different pattern of joint disease, with a greater

frequency of shoulder and hip involvement. The strong relationship between

the presence of ANA and younger age at disease presentation, asymmetric

arthritis, and development of iridocyclitis was confirmed by multivariate

regression analysis.

CONCLUSION: Our results support the hypothesis that patients with similar

characteristics are currently classified into different JIA categories. The

value of ANA positivity as a possible modifier of the current classification

system deserves consideration.

PMID: 15751057

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15751057

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