Factors and glucocorticoid usage affecting the prognosis of
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The rate of glucocorticoid (GC) usage is significantly higher in systemic juvenile idiopathic arthritis (SJIA) than other JIA subtypes. There is no consensus on the duration and dosage of GC treatment. Researchers aimed to investigate the risk factors of polyphasic/persistent disease course and the effect of dose and duration of GC treatment on SJIA prognosis that inferred minimal impact.

A total of 42 patients with SJIA who had been diagnosed for more than two years were included in the study. Monophasic and others (polyphasic/persistent disease course) patients were separated. The first active disease stages and all flares in the entire disease course were tested for risk factors of polyphasic/persistent disease course, which included clinical and laboratory observations of the patients, treatment choices, dosage, and length of GCs.

--Of the 42 SJIA patients, 21 had monophasic, and 21 had polyphasic/persistent disease.

--Cumulative dosages and durations of glucocorticoid treatment were similar in two groups at first flare.

--Durations of the first active disease period were longer in polyphasic/persistent group.

--Active disease duration cut-off value of 1.5 months with sensitivity 85.7%, specificity 52.4% were observed on ROC curve analysis.

--Presence of hepatosplenomegaly at first flare was detected as an independent risk factor of polyphasic/persistent disease both dosage and duration of steroid included multivariate analysis (HR:4,129, p:0,034), (HR:3,992, p:0,038).

--Multivariate recurrent events survival analysis determined ALT levels as risk factor affecting polyphasic/persistent disease (HR:0,986).

In conclusion, the dosage and length of glucocorticoids had no effect on the active disease cycles or disease course in SJIA. Polyphasic/persistent disease should be suspected when there is an ongoing disease cycle of more than 1.5 months, hepatosplenomegaly during the initial disease phase, and elevated ALT levels during recurrences.

Source: https://onlinelibrary.wiley.com/doi/10.1111/ped.14706?af=R