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    Background: Juvenile idiopathic arthritis runs an unpredictable course. Children
    with oligoarticular disease may respond well to intra-articular steroids or have
    recurrent episodes of synovitis. Children with polyarticular disease may respond to
    Methotrexate or require steroids and/or biologics. Currently there are no reliable
    predictors of outcome in early disease, which leads to sub-optimal treatment.
    Methods: We are currently undertaking a five-year prospective study of children
    with newly diagnosed and untreated JIA. All have knee involvement. At outset,
    we obtain synovial biopsies (N ¼ 5) under ultrasound guidance. We then record
    detailed clinical, functional, radiological and laboratory data every 3/12 for two
    years. We are correlating outcomes at one and two years with synovial findings
    recorded at outset. Here we report on those children whom to date we have
    followed for one year.
    Results: Of the first 30 children, 18 had oligoarticular disease. Their disease
    activity score fell from a mean of 3.54 to 1.12 at one year. Ten had a single episode
    of 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 from
    a 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 oligo
    patients, with mean vessel score 6.9 vs. 2.6 (p < 0.05) and mean B-cell score
    1.7 vs. 1.0 (p < 0.05).
    On average, the oligo and polyarticular groups shared a similar degree of
    synovial 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)) and
    distributed mainly within the sub-lining layer (SLL).
    However, we observed significant differences between patients within clinical
    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 and
    inadequate response to treatment.
    We will therefore analyse whether synovial findings can predict outcome for
    each patient.
    Original languageEnglish
    Article number28
    Pages (from-to)ii26
    Issue numberS2
    Publication statusPublished (in print/issue) - 1 Apr 2008


    • Juvenile idiopathic arthritis
    • synovial histopathology


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