Juvenile idiopathic arthritis: Synovial predictors of outcome

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