Initial Respiratory System Involvement in Juvenile Idiopathic Arthritis with Systemic Onset Is a Marker of Interstitial Lung Disease: The Results of Retrospective Cohort Study Analysis
Abstract
:1. Introduction
2. Methods
- Patients must have a diagnosis of SJIA according to International League Against Rheumatism (ILAR) criteria or SJIA-like disease (probable/possible SJIA) and meet the recently proposed criteria for SJIA [9].
- The age of SJIA onset is less than 18 years.
- All routine clinical and laboratory features of SJIA.
- Signs of RSI, such as dyspnea and shortness of breath, associated with other signs of RSI, such as pleurisy, local auscultation phenomenon (crackles, crepitations), acute respiratory distress syndrome (RDR), clubbing, ILD, and PAH.
- Treatment: corticosteroids, biologic (bDMARDS), and non-biologic disease-modifying anti-rheumatic drugs (nbDMARDS).
- Outcomes: remission, improvement or active disease, chronic ILD development.
Statistical Analysis
3. Results
3.1. Patients’ Demography
3.2. Clinical Features
3.3. Laboratory Findings
3.4. Macrophage Activation Syndrome Assessment
3.5. Predictors of the Respiratory System Involvement
3.6. Outcomes
4. Discussion
4.1. A Brief Report of Our Results
4.2. Epidemiology and Clinical Features
4.3. Trisomy 21
4.4. Eosinophilia
4.5. MAS, Subclinical MAS, and LD-SJIA
4.6. Diagnostics of ILD
4.7. Treatment
4.8. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameters | Whole Group n = 200 (%) | SJIA without RSI, n = 150 (%) | SJIA with RSI, n = 50 (%) | p-Value |
---|---|---|---|---|
Demography | ||||
Age of SJIA onset, years, Me (25%:75%) min-max | 5.3 (3.0: 9.1) 0.6–17.4 | 6.0 (3.2: 9.1) 0.6–16.9 | 4.9 (2.4: 9.1) 0.8–17.4 | 0.312 |
Observation, years, Me (25%:75%) min-max | 2.0 (1.0; 3.0) 1.0–17.0 | 2.0 (1.0; 4.0) 1.0–14.0 | 2.0 (1.0; 3.0) 1.0–17.0 | 0.162 |
Females, n (%) | 118 (59.0) | 88 (58.7) | 30 (60.0) | 0.868 |
Clinical features | ||||
Rash, n (%) | 153 (76.5) | 110 (73.3) | 43 (86.0) | 0.067 |
Arthritis, n (%) | 109 (54.5) | 89 (59.3) | 20 (40.0) | 0.017 |
Arthralgia without arthritis, n (%) | 20 (10.0) | 14 (9.3) | 6 (12.0) | 0.586 |
Splenomegaly, n (%) | 92 (46.0) | 58 (38.7) | 34 (68.0) | 0.0003 |
Hepatomegaly, n (%) | 131 (65.5) | 92 (61.3) | 39 (78.0) | 0.032 |
Lymphadenopathy, n (%) | 123 (61.5) | 89 (59.3) | 34 (68.0) | 0.275 |
Coagulopathy, n (%) | 21 (10.5) | 10 (6.7) | 11 (22.0) | 0.002 |
Hemorrhage, n (%) | 12 (6.0) | 3 (2.0) | 9 (18.0) | 0.00004 |
Heart involvement, n (%) | 48 (24.0) | 21 (14.0) | 27 (54.0) | 0.0000001 |
CNS involvement, n (%) | 29 (14.5) | 17 (11.3) | 12 (24.0) | 0.028 |
Renal involvement, n (%) | 21 (10.5) | 9 (6.0) | 12 (24.0) | 0.003 |
Systemic score Me (25%:75%) min-max | 2 (2; 3) 1–4 | 2 (2; 3) 1–4 | 3 (2; 4) 1–4 | 0.009 |
Active joints Me (25%:75%) min-max | 3.0 (1.0:8.0) 0.0–64.0 | 4.0 (1.0:10.0) 0.0–64.0 | 2.0 (0.0:5.0) 0.0–23.0 | 0.040 |
Laboratory parameters | ||||
Hemoglobin, g/L, Me (25%;75%) min-max | 100 (89; 111) 55–142 | 10 3 (91;113) 55–142 | 90 (81; 106) 60–127 | 0.001 |
WBC × 109/L, Me (25%;75%) min-max | 15.1 (9.0; 22.8) 0.1–102.0 | 14.6 (9.4; 22.4) 2.2–101.0 | 16.9 (5.9; 26.8) 0.1–102.0 | 0.964 |
Platelets × 109/L, Me (25%;75%) min-max | 394 (237; 583) 0–1099 | 443 (305; 593) 43–1099 | 201 (87; 492) 0–1038 | 0.00006 |
ESR, mm/h, Me (25%;75%) min-max | 45 (28; 60) 2–120 | 45 (30; 60) 2–120 | 42 (22; 64) 2–120 | 0.944 |
C-reactive protein, mg/L, Me (25%; 75%) min-max | 69 (25;131) 0–423 | 62 (25; 118) 0–423 | 103 (33;154) 0.3–300 | 0.111 |
ALT, U/L, Me (25%;75%) min-max | 33 (19; 78) 6–2558 | 29 (17; 59) 6–911 | 49 (27; 200) 6–2558 | 0.002 |
AST, U/L, Me (25%;75%) min-max | 37 (25; 79) 0–4862 | 33 (24; 55) 0–695 | 94 (38; 244) 13–4862 | 0.0002 |
GGT, U/L, Me (25%;75%) min-max | 37 (21; 98) 8–726 | 30 (20; 67) 8–726 | 86 (32; 199) 12–667 | 0.010 |
ALP, U/L, Me (25%;75%) min-max | 207 (141; 359) 11–1096 | 220 (142; 357) 11–1096 | 176 (109; 417) 75–1064 | 0.908 |
LDH, U/L, Me (25%;75%) min-max | 487 (276; 768) 36–4240 | 451 (257; 624) 36–2770 | 801 (317; 2007) 124–4240 | 0.0005 |
Ferritin, ng/mL, Me (25%;75%) min-max | 533 (159; 2013) 16–111,832 | 383 (139; 1500) 16–73,241 | 1909 (748; 12,000) 31–111,832 | 0.000006 |
Triglycerides, Me (25%;75%) min-max | 1.8 (1.0; 3.0) 0.5–108 | 1.3 (1.0; 2.4) 0.5–107 | 2.8 (2.0; 3.9) 0.8–1080 | 0.0001 |
Prothrombin, % Me (25%;75%) min-max | 86 (73; 101) 15–140 | 89 (78; 103) 53–128 | 75 (63; 93) 15–140 | 0.007 |
Fibrinogen, g\L, Me (25%;75%) min-max | 4.3 (2.0; 6.0) 0.7–101.0 | 5.0 (3.1; 6.0) 1.0–101.0 | 2.0 (1.0; 4.5) 0.7–10.0 | 0.00002 |
Albumin, g\L, Me (25%;75%) min-max | 36.5 (26.0; 43.0) 18.0–58.0 | 39.0 (32.0; 43.0) 21.0–58.0 | 24.0 (23.0; 26.0) 18.0–39.0 | 0.000008 |
MAS assessment | ||||
HScore points, Me (25%;75%) min-max | 103 (72; 155) 23–299 | 91 (71; 130) 23–284 | 156 (110; 220) 33–299 | 0.0000001 |
HScore %, Me (25%;75%) min-max | 2 (1; 32) 0–99 | 1 (1; 7) 0–99 | 32 (2; 96) 1–99 | 0.0000001 |
MAS-HLH2004-criteria [14] n (%) | 22/189 (11.6) | 5/144 (3.5) | 17/45 (37.8) | 0.0000001 |
MAS 2005-criteria [13], n (%) | 28/189 (14.8) | 10/144 (6.9) | 18/45 (40.0) | 0.0000001 |
MAS EULAR/ACR/PRINTO criteria 2016 [12], n (%) | 33/189 (17.5) | 13/144 (9.0) | 20/45 (44.4) | 0.0000001 |
Predictors | OR (95% CI) | Se | Sp | p-Value |
---|---|---|---|---|
ICU admission | 13.7 (4.7; 39.8) | 32.0 | 96.7 | 0.0000001 |
Rash | 2.2 (0.9; 5.4) | 86.0 | 26.7 | 0.067 |
No arthritis | 2.2 (1.1; 4.2) | 60.0 | 59.3 | 0.017 |
Splenomegalia | 3.4 (1.7; 6.7) | 68.0 | 61.3 | 0.0003 |
Hepatomegalia | 2.3 (1.1; 4.7) | 78.0 | 38.7 | 0.032 |
Coagulopathy | 4.0 (1.6; 10.0) | 22.0 | 93.3 | 0.002 |
Hemorrhage | 10.8 (2.8; 41.6) | 18.0 | 98.0 | 0.00004 |
Heart involvement | 7.2 (3.5; 14.9) | 54.0 | 86.0 | 0.0000001 |
Neural involvement | 2.5 (1.1; 5.6) | 24.0 | 88.7 | 0.028 |
Renal involvement | 5.0 (1.9; 12.6) | 24.0 | 94.0 | 0.0003 |
Bone marrow hemophagocytosis | 2.1 (1.1; 4.1) | 46.0 | 71.3 | 0.024 |
Correspondence to HLH2004 criteria [14] | 16.8 (5.7; 49.2) | 37.8 | 96.5 | 0.0000001 |
Correspondence to MAS2016 criteria [12] | 8.9 (3.7; 21.5) | 40.0 | 93.1 | 0.0000001 |
No cervical spine arthritis | 3.6 (1.05; 12.5) | 94.0 | 18.8 | 0.031 |
No elbow arthritis | 2.5 (0.9; 6.7) | 90.0 | 21.5 | 0.071 |
No wrist arthritis | 2.1 (1.02; 4.2) | 74.0 | 42.3 | 0.040 |
Treatment with IVIG | 6.4 (3.1; 13.3) | 48.0 | 87.3 | 0.0000001 |
Hemoglobin ≤ 91.0 g/L | 4.0 (1.9; 8.2) | 58.5 | 73.7 | 0.0001 |
Platelets ≤ 211.0 × 109 | 8.5 (3.8; 18.7) | 54.8 | 87.5 | 0.0000001 |
ALT > 39.0 IU/L | 3.3 (1.6; 6.9) | 65.9 | 63.0 | 0.001 |
AST > 90.0 IU/L | 7.8 (3.5; 17.3) | 51.2 | 88.1 | 0.0000001 |
GGT> 42.0 IU/L | 5.3 (1.8; 15.6) | 68.2 | 71.2 | 0.002 |
LDH > 796.0 IU/L | 7.0 (2.9; 17.3) | 51.6 | 86.8 | 0.000005 |
Ferritin > 918.0 ng/mL | 5.4 (2.4; 12.2) | 73.7 | 65.8 | 0.00002 |
Triglycerides > 2.0 mmol/L | 9.0 (3.2; 25.0) | 78.6 | 71.1 | 0.000004 |
Prothrombin ≤ 75.0% | 5.0 (2.0; 12.8) | 54.8 | 80.6 | 0.0004 |
Fibrinogen ≤ 2.1 g/L | 11.2 (4.3; 28.9) | 63.9 | 86.3 | 0.0000001 |
Albumin ≤ 26.0 g/L | 45.2 (8.0; 256.7) | 78.6 | 92.5 | 0.0000001 |
Systemic count > 3.0 | 26.0 (5.6; 120.3) | 26.0 | 98.7 | 0.0000001 |
HScore > 130.0 | 6.4 (3.1; 13.4) | 65.9 | 76.9 | 0.0000001 |
HScore, % > 7% | 5.7 (2.8; 11.9) | 63.6 | 76.6 | 0.000001 |
Active joints ≤ 4 | 2.2 (1.1; 4.4) | 74.0 | 33.3 | 0.030 |
Outcomes | SJIA without RSI, n = 150 (%) | SJIA with RSI, n = 50 (%) | p-Value |
---|---|---|---|
Patients with remission, n (%) | 132 (88.0) | 39 (78.0) | 0.082 |
Patients discontinued corticosteroids, n (%) | 123 (82.0) | 42 (84.0) | 0.747 |
Withdrawn of nbDMARD, n (%) | 33 (22.0) | 12 (24.0) | 0.770 |
Patients, who had at least one major flare, n (%) | 21 (14.0) | 7 (14.0) | 1.0 |
Patients, who received bDMARD, n (%) | 100 (66.7) | 39 (78) | 0.132 |
Remission on the first bDMARD, n (%) | 74/100 (74) | 27/39 (69.2) | 0.594 |
Patients, whom bDMARD switched, n (%) | 26/100 (26.0) | 12/39 (24.0) | 0.571 |
Second biologic, n (%) Tocilizumab Canakinumab Rituximab Abatacept Etanercept Tofacitinib Adalimumab Anakinra Canakinumab + Tofacitinib | 5/26 (19.2) 10/26 (38.4) 1/26 (3.9) 2/26 (7.7) 2/26 (7.7) 1/26 (3.9) 4/26 (15.4) 1/26 (3.8) 0/26 (0.0) | 2/12 (16.7) 4/12 (33.4) 0/12 (0.0) 1/12 (8.3) 2/12 (16.7) 0/12 (0.0) 1/12 (8.3) 1/12 (8.3) 1/12 (8.3) | 0.816 |
Remission on the second biologic, n (%) | 17/26 (65.4) | 6/12 (50.0) | 0.367 |
Patients, whom bDMARD re-switched, n (%) | 10/26 (38.5) | 5/12 (41.7) | 0.851 |
Remission on the final biologic agent, n (%) | 9/10 (90.0) | 5/5 (100) | 0.465 |
Overall remission, n (%) | 145 (96.7) | 48 (96.0) | 0.824 |
Overall remission on bDMARD, n (%) | 100/100 (100) | 38/39 (97.4) | 0.109 |
Patients with reduced bDMARD, n (%) | 42/100 (42.0) | 18 (46.2) | 0.657 |
Tapering bDMARD, n (%) | 32/100 (32.0) | 14/39 (35.9) | 0.661 |
bDMARD discontinuation, n (%) | 10/100 (10.0) | 4/39 (10.3) | 0.964 |
Flare during/after bDMARD tapering/discontinuation, n (%) | 0/35 (0.0) | 1/16 (6.3) | 0.135 |
Targets for biologics | |||
Successful target | n = 100 (%) | n = 39 (%) | |
Interleukin-6 blockers | 75 (75.0) | 28 (71.8) | 0.751 |
Interleukin-1 blockers | 16 (16.0) | 7 (18.0) | |
Tumor necrosis factor-a blockers | 7 (7.0) | 2 (5.1) | |
Others | 2 (2.0) | 2 (5.1) | |
Infusion reaction on tocilizumab, n (%) | 2 (2.0) | 3 (8.1) | 0.106 |
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Belozerov, K.E.; Isupova, E.A.; Solomatina, N.M.; Gaidar, E.V.; Kaneva, M.A.; Chikova, I.A.; Kalashnikova, O.; Kuznetsova, A.A.; Ivanov, D.O.; Kostik, M.M. Initial Respiratory System Involvement in Juvenile Idiopathic Arthritis with Systemic Onset Is a Marker of Interstitial Lung Disease: The Results of Retrospective Cohort Study Analysis. J. Clin. Med. 2024, 13, 3843. https://doi.org/10.3390/jcm13133843
Belozerov KE, Isupova EA, Solomatina NM, Gaidar EV, Kaneva MA, Chikova IA, Kalashnikova O, Kuznetsova AA, Ivanov DO, Kostik MM. Initial Respiratory System Involvement in Juvenile Idiopathic Arthritis with Systemic Onset Is a Marker of Interstitial Lung Disease: The Results of Retrospective Cohort Study Analysis. Journal of Clinical Medicine. 2024; 13(13):3843. https://doi.org/10.3390/jcm13133843
Chicago/Turabian StyleBelozerov, Konstantin E., Eugenia A. Isupova, Natalia M. Solomatina, Ekaterina V. Gaidar, Maria A. Kaneva, Irina A. Chikova, Olga Kalashnikova, Alla A. Kuznetsova, Dmitry O. Ivanov, and Mikhail M. Kostik. 2024. "Initial Respiratory System Involvement in Juvenile Idiopathic Arthritis with Systemic Onset Is a Marker of Interstitial Lung Disease: The Results of Retrospective Cohort Study Analysis" Journal of Clinical Medicine 13, no. 13: 3843. https://doi.org/10.3390/jcm13133843