Juvenile Idiopathic Arthritis Of The Clinical Features And Quality Of Life Study

Objective: To learn the clinical features and long-term prognosis of juvenile idiopathic arthritis (JIA) in children, in particular quality of life associated with the clinical features and therapeutic options.Method: Patients with JIA hospitalized at Children's Hospital, Chongqing Medical University during 1997 to 2007 were enrolled. Clinical charts of patients were retrospectively reviewed and survey was conducted using a questionnaire indicating quality of life ( CHAQ questionnaires and CHQ questionnaire, adjusted appropriately) either by phone, letter or out-patient follow-up approach. The manner of correlation and logistic regression was used to analyze quality of life associated with the clinical features and therapeutic options.Result:(1)There is a total of 280 hospitalized children, of which 70 cases were surveyed. The majority (74.3%) of patients were diagnosed as systemic onset JIA, and other types of JIA serially polyarticular JIA (22.9%), pauciarticular JIA(2.9%). More than 88% patients had febrile, 49.3% had rash, and varying degrees of joint muscle involvement. Approximately 41.4% presented hepatomegaly or Splenomegaly or lymphadenectasis, 11.6 percent myocardial enzyme abnormalities, 57 percent of children with a different degree of anemia. RF-positive Were found in only three cases, and ANA positive in 5 cases (7.6 %). The acute phase reaction products and immunoglobulins were also increased in the majority of patients.(2)Each patient was treated with NSAIDs. About 47.1% were added prednisone and 42.8 % used methotrexate.(3)The Cronbach Alpha coefficient of questionnaire is 0.9599, with a higher inernal consistency reliability. Each entry in the internal consistency coefficient factors were greater than the factors and the correlation coefficient of other factors. So each entry with its own related analysis,correlation coefficient higher than with other factors, the correlation coefficient, tips the scales validity of the higher constrction.(4) 69 cases with 76.8 percent of the score showed that good quality of life. Of which two cases of children with pauciarticular JIA are poor quality of life. The quality life of systemic onset JIA and the polyarticular JIA with no statistical difference. In-patients in the first five years of permanent joint damage of 22 percent, after five years accounted for 15.7 percent. Less than 5 years old and more than 5-year-old quality of life of the two groups was significant difference, p <0.05.(5) The rank sum test of single-use NSAIDs group and NSAIDs adds other medicine group suggest that the two groups have differences in quality of life(P to 0.026). As using NSAIDs alone, the average rank, 44.8 more than the use of NSAIDs treating with other categories such as average Rank 32.28,suggests that quality of life in the single-use NSAIDs group is poorer than NSAIDs adds other medicine group.(6) The correlation coefficient between the variables of time from onset to formal treatment and quality of life scores is 0.329, P <0.05, and "walking" as the dependent variable for the regression analysis showed regression coefficient was 0.15, wald test results P = 0.016, a Statistical significance, OR 1.15.(7)The related analysis between the variable of grip and clinical factors: the variable grip has the significantly relationship respectively with the "disease onset to regular treatment, the initial number of joint involvement,"(8) The correlation coefficient between "chaq" and the "degree of family harmony," is0.241, p = 0.048 <0.05, suggested that the two had a significant negative correlation.Conclusion:Systemic oneset JIA is the most common type of JIA. Most of JIA patients have a good prognosis. The major factors which may cause the decline in the quality of life are age, duration without therapy after the disease onset, and the compliance to medication. To achieve a better prognosis, more aggressive therapy may be needed and individulized.