Cumulative damage in juvenile idiopathic arthritis: A multi-center study from the Pediatric Rheumatology Arab Group (PRAG).

OBJECTIVES To report the cumulative articular and extra-articular damage in Arab children with JIA and to identify variables that correlate with disease damage. METHODS We conducted a multicenter, cross-sectional study among 14 pediatric rheumatology centers from seven Arab countries. JIA patients who met the ILAR classification criteria and had a disease duration greater than one year were enrolled. Disease activity status was assessed using Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Disease damage was assessed by articular and extra-articular juvenile arthritis damage index (JADI-A and JADI-E). RESULTS A total of 702 (471 female) JIA patients with a median age of 11.3 (IQR 8.0- 14.0) years were studied. Median age at disease onset was five (IQR 2.0- 9.0) years and the median disease duration was four (IQR 2.0- 7.0) years. The most frequent JIA categories were oligoarticular JIA (34.9%), polyarticular JIA (29.5%) and systemic JIA (24.5%). Clinical remission was achieved in 73.9% of patients. At the last clinic visit, 193 patients suffered from joint damage with a mean JADI-A score of 1.7 (SD ±4.5) while 156 patients had extra-articular damage with a mean JADI-E score of 0.5 (SD ±1.1). Patients with enthesitis related arthritis (ERA) had the highest JADI-A score. JADI-A correlated significantly with presence of a family history of JIA. JADI-A and JADI-E had significant correlation with long disease duration. CONCLUSION Cumulative damage was common in this Arab JIA cohort, and consanguinity and JIA in a sibling were frequent findings and were associated with a greater cumulative damage.