Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait

Epidemiology and demographics of juvenile idiopathic arthritis in Africa and Middle East

Juvenile Idiopathic Arthritis (JIA) is a group of chronic heterogenous disorders that manifests as joint inflammation in patients aged <16 years. Globally, approximately 3 million children and young adults are suffering from JIA with prevalence rates consistently higher in girls. The region of Africa and Middle East constitute a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of JIA. There are only a few studies published on epidemiology of JIA in the region. There is an evident paucity of adequate and latest data from the region. This review summarizes the available data on the prevalence of JIA and its subtypes in Africa and Middle East and discusses unmet needs for patients in this region. A total of 8 journal publications were identified concerning epidemiology and 42 articles describing JIA subtypes from Africa and Middle East were included. The prevalence of JIA in Africa and Middle East was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in the region was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be lower as compared to the incidence from other regions. There is a huge unmet medical need in the region for reliable epidemiological data, disease awareness, having regional and local treatment guidelines and timely diagnosis. Paucity of the pediatric rheumatologists and economic disparities also contribute to the challenges regarding the management of JIA.

The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia

Introduction. Juvenile Idiopathic Arthritis (JIA) is the most common chronic arthritis in children. Our aim is to describe demographic, clinical, and laboratory characteristics and treatment of JIA patients followed up in Pediatric Rheumatology clinic in a tertiary center in Saudi Arabia. Methods. Medical records of all patients who are followed up between January 2007 and January 2015 were retrospectively reviewed. Data were collected about demographic, clinical, and laboratory features and treatment. Results. Total patients were 82, males were 31 (37.8%), and mean age of JIA onset was 7.1 ± 3.6 yr. Mean follow-up duration was 2.67±1.6 yr. Systemic onset JIA (SoJIA) was the commonest (36.5%), followed by polyarticular in 29.2% and oligoarticular in 28%. Large and small joints are involved in 76 (92%) and 30 (36.6%), respectively. Main extra-articular feature was fever in 34 (41.4%). Uveitis was diagnosed in 7 (8.5%) and in 5 (21.7%) of oligoarticular JIA. Anemia was found in 49 (59.7%), high ESR in 45 (54.8%), and leukocytosis and thrombocytosis in 33 (40.2%). Positive ANA was found in 30 (36.5%) mainly in oligoarticular subtype as 12 (52%) patients (out of 23) had this positive test. 9 patients (10.9%) required NSAIDs only, 6 patients (7.3%) required NSAIDs and intra-articular steroids only, and 19 (23%) required NSAIDs, methotrexate, steroids, and biologics. Conclusion. SoJIA is the most common JIA subtype in our study. A population based rather than a single center study will give more details about JIA characteristics in Saudi Arabia

Epidemiology of juvenile idiopathic arthritis in Oman

BACKGROUND

There is a worldwide variation in the prevalence and subtype distribution of juvenile idiopathic arthritis (JIA) which may be affected by ethnicity and genetic factors. The purpose of this study is to determine the prevalence, subtype distribution and characteristic features of JIA among Omani children and to compare our results with other ethnic populations worldwide.

METHODS

A population-based, multicenter study among pediatric rheumatology clinics in the Sultanate over a 10 year period between 2004-2013. The diagnosis of JIA and identification of JIA subtypes was based on the ILAR 2004 revised criteria. The hospital charts of these patients were retrospectively reviewed and information was collected. All patients were screened for uveitis by an ophthalmologist using slit lamp examination during regular follow up visits.

RESULTS

The study included a total of 107 cases of JIA in Oman over the study period. Among the 107 patients, 71 % (n = 77) were girls with a female:male ratio of 2.5:1. The mean age of disease onset was 6.85 ± 3.86 years (range 1-13years) while the mean disease duration of 4.8 ± 2.9 years (range 1-11 years). The incidence of JIA was estimated at 2/100,000 with a prevalence of JIA of 20/100,000. The prevalence of JIA in girls was 28/100,000 while the prevalence in boys was 12/100,000. According to disease distribution, the most frequent subtype was polyarticular JIA rheumatoid factor negative (39.2 %) followed by oligoarthritis (31.8 %), systemic (17.8 %), polyarticular JIA rheumatoid factor positive (7.5 %). The unique feature of the Omani cohort is the lack of occurrence of uveitis.

CONCLUSIONS

This is the first epidemiological JIA study conducted in Oman that highlights unique geographical disease phenotype. Compared to Western counties, there were higher frequency of polyarticular disease and lack of occurrence of uveitis. Further studies are needed to evaluate the implications of genetic, ethnic and environmental differences of disease expression.

Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches

Juvenile idiopathic arthritis (JIA) is a group of disorders characterized by arthritis persisting for at least 6 weeks with onset before the age of 16 years. Within this cluster of conditions, the polyarticular form (involving more than four joints within the first 6 months) is further divided based on the presence of rheumatoid factor. Children with polyarticular JIA pose unique diagnostic and therapeutic challenges compared to children with involvement of fewer joints. Polyarticular JIA patients tend to have a more refractory course and therefore are at increased risk for joint damage, resulting in poorer functional outcomes and decreased quality of life. Although the ability to treat this disorder continues to improve, especially with the advent of biologic agents, there is still much about the epidemiology and pathogenesis of polyarticular JIA that is unknown. The epidemiology of polyarticular JIA varies worldwide with a vast difference in reported cases between different global regions as well as within individual countries. Several genetic risk loci have been identified conferring increased susceptibility to JIA, many within the human leukocyte antigen region. Beyond the genome, environmental factors also seem to contribute to the etiology of polyarticular JIA. This review article will focus on the epidemiology and current treatments of polyarticular JIA and briefly discuss genetic and environmental influences on the pathogenesis of JIA as well as new and emerging therapies.

Prevalence and incidence of juvenile idiopathic arthritis: a systematic review

OBJECTIVES

To conduct a systematic literature review on incidence and prevalence of juvenile idiopathic arthritis and to estimate these figures in Europe for 2010.

METHODS

Articles on incidence or prevalence of juvenile idiopathic arthritis were searched in Medline. Pooled incidence and prevalence were calculated overall, by gender, age, classification and arthritis categories. We used the available age and gender pooled rates to standardize the incidence and prevalence on the 2010 European population and estimate the number of cases in Europe in 2010.

RESULTS

Forty-three articles (33 on incidence, 29 on prevalence) were included. Incidence rates varied from 1.6 to 23 and prevalence from 3.8 to 400/100,000. Pooled incidence and prevalence were higher for girls (10.0 [9.4-10.7] and 19.4 [18.3-20.6]/100,000) than boys (5.7 [5.3-6.2] and 11.0 [10.2-11.9]/100,000). Oligoarthritis was the most frequent form (pooled incidence rate 3.7 [3.5-3.9] and prevalence 16.8 [15.9-17.7]/100,000). The direct standardized incidence rate was 8.2 [7.5-9.0] and prevalence 70.2 [62.9-78.1]/100,000. In Europe in 2010, the estimated number of incident cases was 6896 [5481-8578] and 59,175 [44,256-76,983] prevalent cases.

CONCLUSIONS

Incidence and prevalence varied greatly among published reports of juvenile idiopathic arthritis, which may be explained by methodological issues, classification used, and time. Estimating the number of affected children can be useful, especially with the new treatment possibilities.

Paediatrics Rheumatology Clinic Population in Singapore: The KKH Experience

Introduction:

The subspecialty of paediatric rheumatology (PR) is the newest discipline established at KK Women's and Children's Hospital, in 2009. The service provides tertiary care for children with rheumatic diseases in Singapore. Referral population to this subspecialty has not been described in this region.

Methods:

Using the Registry for Childhood Onset Rheumatic Diseases (RECORD), a dedicated web-based data entering system, case descriptions and diagnoses were captured. Standardised descriptions of diagnoses were used.

Results:

Data from January 1, 2009 to March 31, 2012 included 1158 referrals which were analysed. Almost half (42.2%) were diagnosed as non-rheumatic conditions. Systemic vasculitides (28.4%) with Henoch-schonlein purpura (HSP) and Kawasaki disease (KD) were the most common rheumatic diseases. Enthesitis related juvenile idiopathic arthritis (JIA) was common but JIA associated uveitis was rare, so as to antinuclear antibody (ANA) positivity (25.4%). The remaining 36.4% of patients with rheumatic disease had a variety of other conditions. Primary angiitis of the central nervous system (CNS) and recurrent aphthous stomatitis were seen more commonly in local patient than in patients from the west. Of the patients with non-rheumatic disease, 66.3% had orthopaedic/mechanical related conditions, 7.4% had a fever of unknown causes and 4.9% had infections. Mechanical joint pain (67.6%) and hypermobility syndrome (18.5%) were the most frequent referrals.

Conclusion:

Our report described, for the first time, a large single centre cohort of a PR clinic population. Local frequencies or burden of paediatric rheumatic diseases and unique findings were delineated. Targeted education and awareness to both healthcare professionals and members of the public were made possible. However, continuous prospective longitudinal data collection is on-going in order to confirm our initial observation.

Prevalence and clinical pattern of juvenile idiopathic arthritis in a semi-urban area of Bangladesh

OBJECTIVE

To determine the prevalence and clinical pattern of juvenile idiopathic arthritis (JIA) in a semi-urban area of Bangladesh.

METHODOLOGY

A cross-sectional study was carried out among 16 270 children who were selected by using multistage sampling technique from a community of approximately 105 986 children in the Narayanganj district, Bangladesh. Duration of the study was from November 2008 to December 2009. Examinations of the suspected JIA patients were done by the authors in the community as well as in the pediatric rheumatology follow-up clinic at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

RESULTS

The estimated point prevalence of JIA was 60.5 per 100 000 children. In total 10 patients were identified among 16 270 children. Girl : boy ratio was 2.3 : 1.0. The subgroup distribution showed oligoarticular JIA in the majority of patients (60%).

CONCLUSIONS

Prevalence of JIA in this study in a semi-urban area of Bangladesh was consistent with established population-based studies in developed countries. Clinical pattern of JIA patients also had similarities with reports from Western countries.

Prevalence and distribution of juvenile idiopathic arthritis in a region of Western France

OBJECTIVE

To determine the prevalence and distribution of the various forms of juvenile idiopathic arthritis (JIA) in the Poitou-Charentes region of Western France.

METHODS

We surveyed all the practicing rheumatologists and pediatricians in the study region for cases of JIA meeting ILAR criteria seen in 2006 among the population of 305,198 children younger than 16 years of age who resided in the study region. The survey was conducted by means of a questionnaire followed by a phone call. Cases of JIA identified by the survey were reviewed retrospectively.

RESULTS

We identified 48 children with JIA, which yielded a prevalence of 15.7/100,000. Mean age at diagnosis was 6.6 years (range, 1-15 years). Oligoarticular disease was the most common pattern, with 20 (41.6%) patients, a mean age of 4.9 years at diagnosis, and 80% of females. Oligoarticular disease was associated with the best outcomes, and only two (2/20, 10%) patients in this subgroup required disease-modifying therapy. Enthesitis-related arthritis contributed eight (16.6%) patients, with a mean age at diagnosis of 10.7 years and 75% of males. There were nine patients with polyarticular disease and seven with systemic disease; disease severity was greatest in these 16 patients, of whom only two were not taking disease-modifying drugs or glucocorticoids.

CONCLUSION

The prevalence of JIA in Poitou-Charentes was similar to the prevalences reported in other regions of France.

Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor

OBJECTIVE

To study the influence of ethnicity on the risk of developing juvenile idiopathic arthritis (JIA) in a multiethnic community of patients with unrestricted access to health care.

METHODS

A questionnaire on ethnicity was distributed to all patients with JIA being followed up at the Hospital for Sick Children in Toronto, Ontario, Canada. Of 1,082 patients, 859 (79.4%) responded to the questionnaire. To calculate the relative risk (RR) of developing JIA in this study cohort, the results were compared with data from the age-matched general population of the Toronto metropolitan area (TMA) as provided in the 2001 census from Statistics Canada.

RESULTS

European descent was reported by 69.7% of the patients with JIA compared with a frequency of 54.7% in the TMA general population, whereas a statistically significantly lower than expected percentage of the patients with JIA reported having black, Asian, or Indian subcontinent origin. Children of European origin had a higher RR for developing any of the JIA subtypes except polyarticular rheumatoid factor (RF)-positive JIA, and were particularly more likely to develop the extended oligoarticular and psoriatic subtypes. A higher frequency of enthesitis-related JIA was observed among patients of Asian origin, while those of black origin or native North American origin were more likely to develop polyarticular RF-positive JIA.

CONCLUSION

In this multiethnic cohort, European descent was associated with a significantly increased risk of developing JIA, and the distribution of JIA subtypes differed significantly across ethnic groups.

Chronic arthritis in children and adolescents in two Indian health service user populations

Background

High prevalence rates for rheumatoid arthritis, spondyloarthopathies, and systemic lupus erythematosus have been described in American Indian and Alaskan Native adults. The impact of these diseases on American Indian children has not been investigated.

Methods

We used International Classification of Diseases-9 (ICD-9) codes to search two Indian Health Service (IHS) patient registration databases over the years 1998–2000, searching for individuals 19 years of age or younger with specific ICD-9-specified diagnoses. Crude estimates for disease prevalence were made based on the number of individuals identified with these diagnoses within the database.

Results

Rheumatoid arthritis (RA) / juvenile rheumatoid arthritis (JRA) was the most frequent diagnosis given. The prevalence rate for JRA in the Oklahoma City Area was estimated as 53 per 100,000 individuals at risk, while in the Billings Area, the estimated prevalence was nearly twice that, at 115 per 100,000. These rates are considerably higher than those reported in the most recent European studies.

Conclusion

Chronic arthritis in childhood represents an important, though unrecognized, chronic health challenge within the American Indian population living in the United States.

Juvenile rheumatoid arthritis: The Saudi Experience

We retrospectively studied the charts of 115 Arab children with juvenile rheumatoid arthritis (JRA), all of whom satisfied the American College of Rheumatology (ACR) criteria for JRA. They were followed between 1978 and 1993 at King Faisal Specialist Hospital and Research Centre and King Khalid University Hospital in Riyadh, Saudi Arabia. All patients were followed up for at least 18 months. The female to male ratio was 1.2:1, and the mean age of onset of the disease was six years. Ninety of the patients were Saudis and the remainder were Middle Eastern Arabs. The mode of onset was systemic in 44%, polyarticular in 30%, and periarticular in 26%. Chronic uveitis was found in only two of the children (1.7%). Antinuclear antibody (ANA) was determined in 96 patients and was positive in 29 (30%). Amyloidosis was not detected in this study population. The clinical and laboratory manifestations of this disease are presented. This review shows that the spectrum of clinical presentation differs in Arab children from those in the West. Systemic and polyarticular onset subtypes were more common, and the incidence of uveitis and amyloidosis was lower. Whether this reflects a genuine difference in the pattern of the disease, or is due to bias in referral pattern, remains to be detected. The answer is currently being sought through an ongoing prospective study.

Clinico-immunological profile in juvenile rheumatoid arthritis--an Indian experience

From a Pediatric Rheumatology Clinic 361 children diagnosed as juvenile rheumatoid arthritis (JRA) according to American Rheumatism Association-JRA criteria were studied retrospectively for their clinico-immunological profile. The mean age of onset in systemic, pauciarticular and polyarticular onset, JRA subtypes were 5.2, 6.8 and 7.2 years respectively. There was male preponderance in systemic and pauciarticular JRA. In seropositive polyarticular JRA, girls outnumbered boys. The frequency of occurrence of systemic, pauciarticular and polyarticular disease was 87 (24%), 108 (30%) and 166 (46%) respectively. The systemic onset disease was dominated by extra-articular manifestations in terms of fever (100%), rash (57%), hepatomegaly (51%) and lymphadenopathy (25%). The pauci- and polyarticular illnesses were commonly dominated by joint involvement, morning stiffness, and in few patients, by extra-articular manifestations also. The joints were involved symmetrically. Most commonly involved joints in order of decreasing frequency were knee, ankle, wrist and elbow in all the subtypes. Anemia and leucocytosis were observed in majority with higher frequency in systemic onset JRA. The rheumatoid factor (RF) was present in 15% of polyarticular JRA. RF was also present in 7 and 9% of patients with pauciarticular and systemic subtypes respectively. The antinuclear antibody was positive in only 3 out of 66 patients in whom the test was carried out. The demographic profile and trends in clinical features were similar to the studies reported on caucasian population with difference in the actual frequency of various clinical features.