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Gibson, David (2008) JUVENILE IDIOPATHIC ARTHRITIS: SYNOVIAL PREDICTORSOF OUTCOME. In: British Society for Rheumatology, Liverpool. Oxford Journals. Vol 47 (Suppl) 1 pp. [Conference contribution]

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Background: Juvenile idiopathic arthritis runs an unpredictable course. Childrenwith oligoarticular disease may respond well to intra-articular steroids or haverecurrent episodes of synovitis. Children with polyarticular disease may respond toMethotrexate or require steroids and/or biologics. Currently there are no reliablepredictors of outcome in early disease, which leads to sub-optimal treatment.Methods: We are currently undertaking a five-year prospective study of childrenwith newly diagnosed and untreated JIA. All have knee involvement. At outset,we obtain synovial biopsies (N¼5) under ultrasound guidance. We then recorddetailed clinical, functional, radiological and laboratory data every 3/12 for twoyears. We are correlating outcomes at one and two years with synovial findingsrecorded at outset. Here we report on those children whom to date we havefollowed for one year.Results: Of the first 30 children, 18 had oligoarticular disease. Their diseaseactivity score fell from a mean of 3.54 to 1.12 at one year. Ten had a single episodeof swelling of the index joint while eight had 2 or more episodes.Twelve had polyarticular disease. All but two were improved at one year.The mean ESR fell from 44 to 13, and CRP from 33 to 5. Haemoglobin rose froma mean of 10.6 mg/dl to 12.5 mg/dl. The CHAQ improved in all but two.We found significantly more synovial pathology in the poly compared with oligopatients, with mean vessel score 6.9 vs. 2.6 (p<0.05) and mean B-cell score1.7 vs. 1.0 (p<0.05).On average, the oligo and polyarticular groups shared a similar degree ofsynovial hyperplasia and a comparable macrophage distribution. The CD3þ cells(mean 1.7 (0.8–2.7)) were predominately CD4þ (mean 1.7 (0.7–2.6)) anddistributed mainly within the sub-lining layer (SLL).However, we observed significant differences between patients within clinicalsubgroups.Conclusions: Almost 50% of oligoarticular patients had recurrent knee swelling,despite treatment. And while the majority of poly JIA responded to Methotrexate,a significant minority still required steroids or were already on biologics at one year.Infiltrates varied widely between patients; and we predict that synovial pathology,particularly vascularity and B-cell infiltrates, will correlate with a poor outcome andinadequate response to treatment.We will therefore analyse whether synovial findings can predict outcome foreach patient.

Item Type:Conference contribution (Poster)
Faculties and Schools:Faculty of Life and Health Sciences > School of Biomedical Sciences
Faculty of Life and Health Sciences
Research Institutes and Groups:Biomedical Sciences Research Institute
Biomedical Sciences Research Institute > Stratified Medicine
ID Code:24438
Deposited By: Dr David Gibson
Deposited On:07 Jan 2013 09:59
Last Modified:09 Dec 2015 11:10

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