Anti Nuclear Antibody in JIA, predictor for Iridocyclitis

[Mike Bartolatz]

Patients with antinuclear antibody-positive juvenile idiopathic arthritis
constitute a homogeneous subgroup irrespective of the course of joint
disease

Arthritis & Rheumatism Volume 52, Issue 3 , Pages 826 - 832

http://www3.interscience.wiley.com/cgi- ... 6/ABSTRACT

Objective
We recently hypothesized that in the International League of Associations
for Rheumatology (ILAR) classification of juvenile idiopathic arthritis
(JIA), the presumably homogeneous patient group characterized by early onset
of disease, a female predilection, the presence of antinuclear antibodies
(ANA), asymmetric arthritis, and the risk for iridocyclitis is classified
into different categories. We sought to investigate whether ANA-positive
patients belonging to the ILAR categories of oligoarthritis and rheumatoid
factor (RF)-negative polyarthritis share homogeneous features and to compare
these features with those of ANA-negative patients with JIA in the same
categories.

Methods
We identified patients who were followed up during a 15-year period. All
patients had JIA according to the ILAR criteria, with oligoarticular or
polyarticular onset. ANA positivity was defined as 2 or more positive
results at a titer of 1:160. Demographic and clinical features, including
the number of joints involved over time and measures of JIA severity at the
last followup visit, were recorded retrospectively.

Results
A total of 256 patients were included: 190 were ANA positive (109 had
persistent oligoarthritis, 48 had extended oligoarthritis, and 33 had
RF-negative polyarthritis), and 66 were ANA negative (35 had RF-negative
polyarthritis, and 31 had oligoarthritis). All patients who were positive
for ANA were similar in terms of age at disease presentation, female-to-male
ratio, and frequency of symmetric arthritis and iridocyclitis.

Compared with ANA-positive patients with polyarticular disease, ANA-negative
patients with polyarticular arthritis were older at disease presentation and
had a lower frequency of iridocyclitis, a higher frequency of symmetric
arthritis, a greater cumulative number of joints affected over time, and a
different pattern of joint disease, with a greater frequency of shoulder and
hip involvement.

The strong relationship between the presence of ANA and younger age at
disease presentation, asymmetric arthritis, and development of iridocyclitis
was confirmed by multivariate regression analysis.

Conclusion
Our results support the hypothesis that patients with similar
characteristics are currently classified into different JIA categories. The
value of ANA positivity as a possible modifier of the current classification
system deserves consideration.

Patients with antinuclear antibody-positive juvenile idiopathic arthritis
constitute a homogeneous subgroup irrespective of the course of joint
disease

Angelo Ravelli 1 *, Enrico Felici 1, Silvia Magni-Manzoni 2, Angela
Pistorio 1, Cristina Novarini 1, Elena Bozzola 2, Stefania Viola 1, Alberto
Martini 1
1IRCCS G. Gaslini, Genoa, Italy 2Università di Pavia, IRCCS Policlinico S.
Matteo, Pavia, Italy

*Correspondence to Angelo Ravelli, Pediatria II, IRCCS G. Gaslini, Largo G.
Gaslini 5, 16147 Genoa, Italy

email: Angelo Ravelli (angeloravelli@ospedale-gaslini.ge.it)


[Non-text portions of this message have been removed]