title: Disease course, outcome, and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years.
abstract: OBJECTIVE
  To investigate disease course, outcome, and predictors of outcome in an unselected population-based cohort of individuals diagnosed with juvenile chronic arthritis (JCA) followed for 17 years.
  
  
  METHODS
  The cohort consisted of 132 incidence JCA cases identified 1984-1986 according to EULAR criteria. At 5-year followup, 129 individuals underwent joint assessment, laboratory measurements, radiographic examination, and medication and functional assessment. At 17-year followup, 86 were examined with joint assessment, laboratory measurements, medication assessment, Health Assessment Questionnaire (HAQ), Keitel functional test (KFT), and Medical Outcomes Study Short Form-36 (SF-36).
  
  
  RESULTS
  At 17-year followup, 40% were in remission, 44% changed subgroups, median HAQ score was 0.0 (range 0.0-1.5), and median KFT was 100 (range 54-100). SF-36 scores were significantly lower compared to a reference group. Thirty-nine percent of those in remission at 5-year followup were not in remission at 17-year followup. In multivariate analyses of variables from the 17-year followup: remission was predicted by remission at 5-year followup (OR 4.8); HAQ > 0 by rheumatoid factor (RF)-positivity at 5-year followup (OR 3.6); KFT < 100 by nonremission (OR 11.3); and RF-positivity (OR 5.6) at 5-year followup; and the SF-36 physical component summary score above average of the reference group by remission at 5-year followup (OR 5.8).
  
  
  CONCLUSIONS
  This longterm study of 86 individuals with JCA showed large variability of disease courses and of impaired health-related quality of life. Sixty percent were not in remission at 17-year followup. Longterm outcome was best predicted by and associated with characteristics at 5-year followup rather than those at onset.
authors: Department of Rheumatology and Inflammation Research, The Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden. lennart.bertilsson2@comhem.se
authors: Lennart
authors: L
authors: Bertilsson
authors: Boel
authors: B
authors: Andersson-Gäre
authors: Anders
authors: A
authors: Fasth
authors: Ingemar F
authors: IF
authors: Petersson
authors: Helena
authors: H
authors: Forsblad-D'elia
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D020127:Recovery of Function; D012074:Remission Induction; D013548:Sweden / Q000453:epidemiology; D063189:Symptom Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents
keywords: JUVENILE CHRONIC ARTHRITIS; JUVENILE IDIOPATHIC ARTHRITIS; JUVENILE RHEUMATOID ARTHRITIS; OUTCOME ASSESSMENT; PROGNOSIS