To evaluate long-term outcomes and prognostic factors in patients with juvenile idiopathic arthritis (JIA), presenting as oligoarthritis, who received IAC as the first treatment for their disease. We conducted retrospective study at the University Children’s Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups. We included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77). Almost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy.

中文翻译：

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109例幼年特发性少关节炎儿童首次关节内注射皮质类固醇后的长期随访


旨在评估幼年特发性关节炎 (JIA) 患者的长期结局和预后因素，该患者表现为少关节炎，接受 IAC 作为其疾病的首次治疗。我们于 2015 年 1 月至 2023 年 5 月在斯洛文尼亚卢布尔雅那大学儿童医院对临床表现为少关节炎的幼年特发性关节炎儿童进行了回顾性研究，接受关节内皮质类固醇注射（IAC）作为初始治疗。收集患者和治疗数据，并根据后期治疗需要将结果分为三组：不需要治疗、仅需要额外的 IAC 和需要全身治疗。最后一组根据bDMARD的要求进一步划分。对数秩 (Mantel-Cox) 生存分析比较了不同结果组。我们纳入了 109 名表现为少关节炎的 JIA 患者（63% 为女性），他们首先接受了 IAC 治疗。 IAC 的平均年龄为 8.0 岁，随访时间为 4.3 年。值得注意的是，38.5% 的患者在 IAC 后不需要额外的治疗，而 15.5% 的患者仅需要额外的 IAC。 45.9% 的患者需要全身治疗，主要是甲氨蝶呤 (MTX)，平均在 IAC 后 7.8 个月开始。 IAC 后平均 2.2 年，22% 的患者开始生物治疗。注射关节的数量与生物制剂的需求相关。在最后一次随访时，88.9% 的患者患有非活动性疾病。 ANA 阳性（P = 0.049，卡方 3.89）和 HLA B27 抗原存在（P = 0.050，卡方 3.85）与全身治疗的需要相关。与其他患者相比，8 岁以上、ANA 和 HLA B27 阴性的儿童亚组所需的全身治疗 (25.8%) 和生物治疗 (9.6%) 显着减少（p = 0.050，卡方 3.77）。 几乎 40% 需要 IAC 的少关节 JIA 儿童并未进展为慢性疾病。年龄较小、ANA 阳性和 HLA B27 存在是全身治疗的预测因素，而注射关节的数量则预测了未来对生物治疗的需求。