Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South AfricaReport as inadecuate




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Pediatric Rheumatology

, 10:35

First Online: 10 October 2012Received: 24 April 2012Accepted: 04 October 2012

Abstract

BackgroundJuvenile idiopathic arthritis JIA is a disease that shows wide variations between differing populations. Since the recent international consensus on classification criteria, JIA has been widely described in many countries and population groups. There has been almost no data that describes JIA in an African, specifically Sub-Saharan African, setting. Therefore, the aim of this study is to describe disease characteristics, disease course, and functional disability in two tertiary centres in the Western Cape, South Africa and compare the findings to other JIA populations.

MethodsEighty-six children were recruited during random clinic visits to rheumatology clinics at Tygerberg and Groote Schuur Hospital between April 2010 and April 2011. Children were diagnosed using International League of Associations for Rheumatology ILAR 2001 classification criteria. Consent was obtained and medical records examined. The Childhood Health Assessment Questionnaires CHAQ and visual analogue scales VAS for pain and general well-being were completed and all children were examined by a researcher in conjunction with a paediatric rheumatologist. HIV status as well as tuberculosis disease and treatment were investigated.

ResultsA total of 86 children were enrolled. Eight children were excluded 2 HIV arthropathy, 1 TB arthritis, 1 SLE, 4 with insufficient data, leaving a total of 78 patients. There was an equal female to male ratio-39 males and 39 females. There were 6 systemic JIA patients 7.69%, 17 persistent oligoarthritis 21.79%, 4 extended oligoarthritis 5.12%, 11 polyarthritis rheumatoid factor RF positive 14.10%, 21 polyarthritis RF negative 26.9%, 1 psoriatic arthritis 1.28%, and 18 enthesitis-related arthritis 23%. The median CHAQ for the group was 0.5 IQR 0.1-1.25, the median VAS for pain was 18 mm IQR 4–42 and median VAS for general well-being was 25 mm IQR 3–49. Enthesitis-related arthritis and polyarthritis disease subtypes in this South African population may be more common than seen in JIA populations described in northern Europe, India, United Kingdom, and Turkey.

ConclusionThis Western Cape South African JIA population appears to have a different profile of JIA than what has been described elsewhere. Enthesitis-related arthritis and polyarthritis disease subtypes appear to be more prevalent. There are also significant challenges in this setting such as later presentation to pediatric rheumatologists, different disease characteristics, and variable disease courses.

KeywordsJuvenile idiopathic arthritis South Africa Clinical characteristics Functional disability AbbreviationsJIAJuvenile idiopathic arthritis

IQRInterquartile range

ILARInternational league of associations for rheumatology

HIVHuman immunodeficiency virus

TBTuberculosis

PRINTOPaediatric international trials organisation

UKUnited kingdom

CRPC reactive protein

ESRErythrocyte sedimentation rate

HBHaemoglobin

PltPatelets

ANAAnti-nuclear antibody

RFRheumatoid factor

HLAB27Human leukocyte antigen B27

ASTAspartime transaminase

ALTAlanine transaminase

ELISAEnzyme linked immunosorbent assay

CHAQChildhood health assessment questionairre

CIConfidence interval

VASVisual analogue scale

ERAEnthesitis related arthritis

CAPSChildhood arthritis prospective study.

Electronic supplementary materialThe online version of this article doi:10.1186-1546-0096-10-35 contains supplementary material, which is available to authorized users.

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Author: Kate Weakley - Monika Esser - Christiaan Scott

Source: https://link.springer.com/







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