İlknur Girişgen, Beyza Akdağ, Selçuk Yüksel, Gülçin Otar Yener, Zahide Ekici Tekin, Ebru Nevin Çetin

Türkiye İç Batı Anadolu Bölgesi’ndeki bir merkezde jüvenil idiyopatik artrit

Amaç: Kliniğimizde izlem ve tedavi edilen jüvenil idiyopatik artrit tanılıhastaların demografik verilerini, alt gruplarına dağılımını, tedaviye yanıtlarını ve uzun dönem izlemlerini ortaya koymak, ulusal ve uluslararası veriler ile karşılaştırmaktır.Gereç ve Yöntemler: Ocak 2012 ile Ocak 2018 tarihleri arasında jüvenilidiyopatik artrit tanısı alarak tedavi başlanan, düzenli kontrole gelen 116hastanın dosyası incelendi. Demografik bulgular, aldığı tedaviler, aktif/inaktif hastalık (ilaçlı ve ilaçsız) ve tedaviye yanıt durumları değerlendirildi.Bulgular: Uluslararası Romatoloji Derneği Birliği ölçütlerine göre jüvenilidiyopatik artrit alt tipleri 38 entezit ilişkili artrit, 37 oligoartiküler, 17 romatoid faktör (-) poliartiküler, 15 sistemik, 5 romatoid faktör (+) poliartiküler, 4 psöriatik jüvenil idiyopatik artrit olarak değerlendirildi. Toplamdakız erkek oranı 1,5 idi. İlk yakınma ile tanı konulması arasındaki gecikmesüresi ortalama 5,7±5,2 aydı. En erken tanı alan sistemik tipte hastalar, engeç tanı alan hastalar ise poliartiküler ve entezit ilişkili alt tipte olanlardı. Hastaların %32’sine yalnızca metotreksat tedavisi verilirken, %38’ineek biyolojik ilaçlar verildi. Her iki tedavi grubunda inaktif zamana geçişsüresi en kısa oligoartiküler, en uzun entezit ilişkili artrit grubundaydı.Çalışma döneminde 38 hasta ilaçsız iyilik hali (en yüksek oran %53,3 ilesistemikte), 71 hasta ilaçlı iyilik hali (en yüksek oran %70,2 ile oligoartikülerde) olarak izlenmekteydi. Hastaların %94’ünde iyilik hali sağlandı.Çıkarımlar: Entezit ilişkili artritin dikkat çekici bulgusu olan entezitin rutin fizik muayenede göz ardı edilmemesi gerekmektedir. Entezit farkındalığı, entezit ilişkili artritli çocuklarda tanı gecikmesinin önlenmesinekatkıda bulunabilir.

Juvenile idiopathic arthritis in a center in the Western Anatolia region in Turkey

Aim: To demonstrate the demographic data, subgroup distributions, responses to treatment and outcomes of long-term follow-up in patients who were followed up and treated in our clinics with a diagnosis of juvenile idiopathic arthritis, and to compare these data with national and international data. Material and Methods: The files of 116 patients who had been diagnosed as having juvenile idiopathic arthritis, were initiated on treatment and presented for regular follow-up visits between January 2012 and January 2018, were examined. Their demographic findings, treatments, active/inactive disease states (on-medication and off-medication) and treatment response states were evaluated. Results: According to the International League of Associations for Rheumatology criteria, the subtypes were specified as enthesitis-related arthritis (n=38), oligoarticular (n=37), rheumatoid factor (-) polyarticular (n=17), systemic (n=15), rheumatoid factor (+) polyarticular (n=5), and psoriatic juvenile idiopathic arthritis (n=4). In total, the female/male ratio was found to be 1.5. The mean delay time between the first complaint and the diagnosis was found to be 5.7±5.2 months. The patients with systemic type were diagnosed at the earliest, while the patients with polyarticular and enthesitis-related subtypes were diagnosed at the latest. Thirty-two percent of the patients were treated with methotrexate alone, and 38% were given additional biologic drugs. In both treatment groups, the time to achieve inactive disease was the shortest in the oligoarticular group and the longest in the enthesitis-related arthritis group. In the study period, 38 patients were in remission off-medication (the highest rate (53.3%) was observed in the systemic group) and 71 patients were in remission on-medication (the highest rate (70.2%) was observed in the oligoarticular group). Remission was obtained in 94% of the patients. Conclusion: Enthesitis which is the remarkable finding of enthesitis-related arthritis, should not be overlooked in routine physical examination. Awareness of enthesitis can contribute to the prevention of diagnostic delay in children with enthesitis-related arthritis.

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