Clinical profile and juvenile arthritis damage index in children with juvenile idiopathic arthritis: A study from a tertiary care center in south India.
OBJECTIVE
This study was designed to determine the clinical profile of juvenile idiopathic arthritis (JIA) and its morbidity using the juvenile arthritis damage index (JADI) score at a tertiary care center in northern Kerala and to compare with data from India and abroad.


METHODS
A hospital-based cross-sectional study was carried out over a period of one and half years from January 2011 to July 2012. Clinical and laboratory profiles and morbidity were assessed.


RESULTS
There were 62 children (mean age 8.9 ± 3.8 years) with JIA during this period with a median duration of disease of 24 months (2-151 months). The most common subgroup was polyarticular JIA (n = 26; 41.9%) followed by systemic JIA (sJIA) (n = 20; 32.3%), oligoarticular JIA (n = 15; 24.2%) and enthesitis-related arthritis (n = 1; 1.6%). The most common joints involved at presentation were the knee (38.7%) followed by the ankle (25.8%). Weights and heights were less than the fifth centile in 25.8% and 11.3%, respectively, being most affected in sJIA. The frequencies of articular and extra-articular morbidities were highest in sJIA and showed negative correlation with age at onset and positive correlation with the duration of illness. Macrophage activation syndrome was diagnosed in 50% of sJIA with a mortality of 33.3%. We experienced lower frequency of articular (30.6% vs. 60.7%) and extra-articular damage (24.2% vs. 39.3%), growth failure (19.3% vs. 68.5%) and pubertal delay (4.8% vs. 20.2%) compared to another study from north India.


CONCLUSIONS
Our study shows lower frequency of morbidity in JIA; probably related to a better healthcare system facilitating early diagnosis and treatment in this part of the country.
Department of Pediatrics, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India.
Nisha Vengassery Balakrishnan
NVB
Menon
Department of Pediatrics, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India.
Geetha
G
Peethambaran
Department of Pediatrics, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India.
Ashraf Thottoli
AT
Puthiyapurayil
Department of Pediatrics, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India.
Cherian
C
Nambudakath
Department of Pediatrics, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, Kerala, India.
Riazudeen
R
Arakkal
D000293:Adolescent; D017668:Age of Onset; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007596:Joints / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
D015415:Biomarkers
juvenile arthritis damage index; juvenile idiopathic arthritis; macrophage activation syndrome; pediatric rheumatology