Background: Juvenile Idiopathic Arthritis (JIA) refers to a heterogeneous group of chronic arthritides with onset before 16 years of age and unknown etiology. Some clinical observations suggest that the forms of JIA that emerged during the SARS-CoV-2 pandemic differ in part from those in the pre-COVID period. It is known that the SARS-CoV-2 virus is a potent inducer of autoimmune phenomena, both during infection and in the weeks following. In adults, the clinical spectrum of COVID-19-related rheumatic conditions ranges from asymmetrical monoarthritis/oligoarthritis (51%) to symmetrical polyarthritis of the small joints similar to rheumatoid arthritis (20%) to axial forms (11%). Aim of the Study: To compare the epidemiological, demographic, and clinical characteristics of patients with JIA who presented during the four years of the SARS-CoV-2 pandemic (2020-2023) with those of patients with disease onset in the pre-pandemic four-year period (2016-2019). Materials and Methods: A retrospective analysis was conducted on a prospective data collection of patients diagnosed with oligoarticular and polyarticular JIA, classified according to ILAR criteria, and followed at the Pediatric Rheumatology Unit of the Azienda Ospedale-Università di Padova. Four diagnostic groups were considered: Oligo anche Poly preCOVID, Oligo and Poly postCOVID. Besides demographic parameters (sex, date of symptom onset, age at diagnosis, type of arthritis, presence of uveitis), the following laboratory data were also considered: presence of antinuclear antibodies (ANA) with titer > 1:160, Rheumatoid Factor, and HLA-B27 positivity. Additionally, the type of therapy, anti-inflammatory and/or immunosuppressive, and disease status at 6, 12, and 18 months from diagnosis were evaluated. The outcome was defined according to Wallace criteria as: Total Clinical Remission (CR) - inactive joint disease in the absence of therapy for at least 12 consecutive months; Clinical Remission on Medication (CRM) - absence of disease for at least 6 consecutive months while still on therapy; Active Disease (A) - presence of signs and symptoms of joint or ocular disease. To gain a clearer understanding of the role that SARS-CoV-2 infection played in the onset of the disease, the modes of diagnosis (personal history of COVID-19, positive serology for COVID-19 compatible with the presumed interval between onset and patient age) and the interval between the viral infection and the onset of arthritis were considered. Results: Polyarticular JIA forms during the 2020-2023 period show a higher prevalence in males compared to the 2016-2019 cohort (56.6% vs 11.8%). No statistically significant differences were found regarding age at diagnosis, immunological data (ANA, RF, HLA-B27), presence of uveitis, therapy administration, or prognosis. However, for oligoarticular JIA forms, the age at diagnosis was higher in the COVID-related group (8.6 vs 6.2, p <0.05). The different onset of uveitis in the COVID-related oligo group was strongly trending toward significance (3.3% vs 18.5%, p=0.05), while ANAs were less frequent (66.7% vs 84.7%, p=0.04). Second-line therapies (CS, DMARDs, and BA) were used less frequently in the COVID-related group (CS p=0.015, DMARDs p=0.004, and BA p=0.003). Finally, the outcome in COVID-related forms was benign: in the first 18 months of the disease, 60% of patients achieved total remission, in an average time of about 12 months, whereas this occurred in only 35.4% of pre-COVID patients, in an average time of 15 months. Conclusions: In the COVID-19 four-year period, polyarticular JIA did not show significant differences compared to the pre-COVID period. However, oligoarticular JIA that emerged after COVID-19 demonstrated a less severe clinical course, with less need for immunosuppressive therapies and total remission in more than half of the patients within an average of one year.
Presupposti: L’artrite idiopatica giovanile (AIG) identifica un gruppo eterogeneo di artriti croniche, ad esordio antecedente i 16 anni ed eziologia sconosciuta. Osservazioni cliniche suggeriscono che le forme esordite durante la pandemia da SARS-CoV-2 siano in parte diverse da quelle del periodo pre-Covid. Il virus SARS-CoV-2 è noto induttore di fenomeni autoimmuni, in corso di infezione e settimane successive. Negli adulti, le manifestazioni reumatiche legate al Covid-19 osservate: monoartrite/oligoartrite asimmetrica (51%), poliartrite simmetrica delle piccole articolazioni simil-artrite reumatoide (20%), forme assiali (11%). Scopo dello studio: confrontare le caratteristiche epidemiologiche, demografiche e cliniche di pazienti con AIG esordita nel quadriennio della pandemia da Sars-Cov2 (2020-2023) con la coorte di pazienti con esordio della malattia nel quadriennio pre-pandemico (2016-19). Materiali e metodi: è stata effettuata un’analisi retrospettiva di una raccolta prospettica di dati di pazienti con diagnosi di AIG oligoarticolare e poliarticolare, classificate in base ai criteri ILAR e seguiti presso l’Unità Operativa di Reumatologia Pediatrica dell’Azienda Ospedale-Università di Padova. Sono stati considerati 4 gruppi diagnostici: Oligo e Poli pre-Covid, Oligo e Poli post-Covid. Sono stati considerati i parametri demografici (sesso, data di esordio dei sintomi, età alla diagnosi, tipo di artrite, presenza di uveite) e i seguenti dati di laboratorio: presenza di anticorpi antinucleo (ANA) con titolo > 1:160, Fattore Reumatoide e positività al locus di istocompatibilità HLA-B27. Inoltre,il tipo di terapia, antinfiammatoria e/o immunosoppressiva, e lo stato di malattia a 6,12 e 18 mesi dalla diagnosi. L'outcome è stato definito in base ai criteri di Wallace come: remissione clinica totale (CR, Clinical Remission) ovvero malattia articolare inattiva in assenza di terapia per almeno 12 mesi continuativi; remissione parziale (Clinical Remission on Medication (CRM), ovvero assenza di malattia per almeno 6 mesi continuativi con terapia ancora in atto; malattia attiva (A,Active), ovvero presenza di segni e sintomi di malattia articolare o oculare. Per definire il ruolo l’infezione da SARS-CoV-2 sull’esordio della malattia, sono state considerate le modalità di diagnosi (anamnesi personale e sierologia positive per COVID-19 compatibile con l’intervallo presunto tra l’esordio e l’età del paziente) e l’intervallo tra l’infezione virale e l’esordio dell’artrite. Risultati: Le forme di AIG poliarticolari del periodo 2020-23 presentano prevalenza del sesso maschile rispetto alla coorte 2016-19 (56.6% vs 11.8%). Non risultano differenze statisticamente significative per età alla diagnosi, dati immunologici (ANA, FR, HLA-B27) e presenza di uveite, o per assunzione di terapie e prognosi. Le forme di AIG oligoarticolari, presentano l’età alla diagnosi maggiore nel gruppo oligo COVID-correlato (8.6 vs 6.2, p <0.05). La differente insorgenza di uveite nel gruppo oligo COVID-correlato è fortemente tendente alla significatività (3.3% vs 18.5%, p=0.05) mentre gli ANA sono meno frequenti (66.7% vs 84.7%, p=0.04). Le terapie di seconda linea (CS, DMARDs e BA) vengono utilizzate meno nel gruppo COVID-correlato (CS p=0.015, DMARDs p=0.004 e BA p=0.003). L’outcome, nelle forme COVID-correlate risulta benigno: nei primi 18 mesi di malattia il 60% dei pazienti raggiunge la remissione totale, in media in 12 mesi, mentre nel quadriennio pre-Covid il 35.4% in media in 15 mesi. Conclusioni: Nel quadrienno COVID,le AIG poliarticolari non hanno presentato differenze significative rispetto al periodo pre-Covid. Le AIG oligoarticolari insorte dopo l’infezione COVID hanno dimostrato un andamento clinico meno severo, minor assunzione di terapie immunosoppressive e remissione totale in più di metà dei pazienti, in media in un anno.
Artrite idiopatica giovanile con esordio in epoca Covid: quali differenze rispetto al passato? Studio prospettico monocentrico
GAMBARO, SVEVA
2023/2024
Abstract
Background: Juvenile Idiopathic Arthritis (JIA) refers to a heterogeneous group of chronic arthritides with onset before 16 years of age and unknown etiology. Some clinical observations suggest that the forms of JIA that emerged during the SARS-CoV-2 pandemic differ in part from those in the pre-COVID period. It is known that the SARS-CoV-2 virus is a potent inducer of autoimmune phenomena, both during infection and in the weeks following. In adults, the clinical spectrum of COVID-19-related rheumatic conditions ranges from asymmetrical monoarthritis/oligoarthritis (51%) to symmetrical polyarthritis of the small joints similar to rheumatoid arthritis (20%) to axial forms (11%). Aim of the Study: To compare the epidemiological, demographic, and clinical characteristics of patients with JIA who presented during the four years of the SARS-CoV-2 pandemic (2020-2023) with those of patients with disease onset in the pre-pandemic four-year period (2016-2019). Materials and Methods: A retrospective analysis was conducted on a prospective data collection of patients diagnosed with oligoarticular and polyarticular JIA, classified according to ILAR criteria, and followed at the Pediatric Rheumatology Unit of the Azienda Ospedale-Università di Padova. Four diagnostic groups were considered: Oligo anche Poly preCOVID, Oligo and Poly postCOVID. Besides demographic parameters (sex, date of symptom onset, age at diagnosis, type of arthritis, presence of uveitis), the following laboratory data were also considered: presence of antinuclear antibodies (ANA) with titer > 1:160, Rheumatoid Factor, and HLA-B27 positivity. Additionally, the type of therapy, anti-inflammatory and/or immunosuppressive, and disease status at 6, 12, and 18 months from diagnosis were evaluated. The outcome was defined according to Wallace criteria as: Total Clinical Remission (CR) - inactive joint disease in the absence of therapy for at least 12 consecutive months; Clinical Remission on Medication (CRM) - absence of disease for at least 6 consecutive months while still on therapy; Active Disease (A) - presence of signs and symptoms of joint or ocular disease. To gain a clearer understanding of the role that SARS-CoV-2 infection played in the onset of the disease, the modes of diagnosis (personal history of COVID-19, positive serology for COVID-19 compatible with the presumed interval between onset and patient age) and the interval between the viral infection and the onset of arthritis were considered. Results: Polyarticular JIA forms during the 2020-2023 period show a higher prevalence in males compared to the 2016-2019 cohort (56.6% vs 11.8%). No statistically significant differences were found regarding age at diagnosis, immunological data (ANA, RF, HLA-B27), presence of uveitis, therapy administration, or prognosis. However, for oligoarticular JIA forms, the age at diagnosis was higher in the COVID-related group (8.6 vs 6.2, p <0.05). The different onset of uveitis in the COVID-related oligo group was strongly trending toward significance (3.3% vs 18.5%, p=0.05), while ANAs were less frequent (66.7% vs 84.7%, p=0.04). Second-line therapies (CS, DMARDs, and BA) were used less frequently in the COVID-related group (CS p=0.015, DMARDs p=0.004, and BA p=0.003). Finally, the outcome in COVID-related forms was benign: in the first 18 months of the disease, 60% of patients achieved total remission, in an average time of about 12 months, whereas this occurred in only 35.4% of pre-COVID patients, in an average time of 15 months. Conclusions: In the COVID-19 four-year period, polyarticular JIA did not show significant differences compared to the pre-COVID period. However, oligoarticular JIA that emerged after COVID-19 demonstrated a less severe clinical course, with less need for immunosuppressive therapies and total remission in more than half of the patients within an average of one year.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/66084