Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Antinuclear Antibody Positive Patients Should Be Grouped as a Separate Category in the Classification of Juvenile Idiopathic Arthritis.

Ravelli2,  Angelo, Varnier4,  Giulia C., Oliveira5,  Sheila K., Castell4,  Esteban, Arguedas4,  Olga, Magnani4,  Alessandra, Pistorio4,  Angela

IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
IRCCS G. Gaslini and Università di Genova, Genova, Italy
IRCCS G. Gaslini and Università di Genova, Genova, Italy
IRCCS G. Gaslini, Genova, Italy
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

Objective:

We hypothesized that in the International League of Associations for Rheumatology (ILAR) classification of juvenile idiopathic arthritis (JIA), patients with similar characteristics are classified into different categories. We sought to investigate whether ANA-positive patients belonging to the ILAR categories of oligoarthritis, rheumatoid factor (RF)-negative polyarthritis, psoriatic arthritis, and undifferentiated arthritis share homogeneous features and to compare these features with those of ANA-negative patients in the same categories.

Methods:

We identified all JIA patients who were followed up during a 22-year period. ANA positivity was defined as >= 2 positive results at a titer of >= 1:160. Demographic and clinical features were recorded retrospectively and compared among ANA-positive and ANA-negative patients.

Results:

A total of 1219 patients fulfilled the ILAR criteria for JIA. Patients with systemic arthritis, RF-positive polyarthritis and enthesitis-related arthritis were excluded from the study. The remaining 971 patients belonging to the ILAR categories of oligoarthritis (n=649), RF-negative polyarthritis (n=223), psoriatic arthritis (n=37), and undifferentiated arthritis (n=62) were combined and classified according to their ANA status as follows: 711 (73.2%) were ANA positive, 149 (15.3%) were ANA negative, and 111 (11.4%) had a doubtful ANA status. Patients with a doubtful ANA status were excluded from the analysis. The number of ANA determinations per patient in the 860 patients who had the ANA status specified ranged from 2 to 20 (mean 5.4); the total number of determinations was 4610. All ANA-positive patients were similar in terms of age at disease presentation, female-to-male ratio, and frequency of asymmetric arthritis and iridocyclitis. Compared with ANA-positive patients, ANA-negative patients were older at disease presentation and had a lesser female prevalence, a lower frequency of iridocyclitis and asymmetric arthritis, a greater number of affected joints over time, and a different pattern of arthritis. The close relationship between the presence of ANA and younger age at disease presentation, female predilection, asymmetric arthritis, and development of iridocyclitis was confirmed by multivariate, multiple correspondence, and cluster analysis. The figure shows the 2-dimensional scatterplot of multiple correspondence analysis.

This analysis led to the identification of 2 patient groups with distinct characteristics: the circle identifies the interrelated variables that define the ANA-positive patient profile.

Conclusion:

Our findings substantiate the hypothesis that ANA-positive patients classified into different JIA categories by current ILAR criteria constitute a homogeneous patient population, irrespective of the course of joint disease or the presence of psoriatic features.

To cite this abstract, please use the following information:
Ravelli, Angelo, Varnier, Giulia C., Oliveira, Sheila K., Castell, Esteban, Arguedas, Olga, Magnani, Alessandra, et al; Antinuclear Antibody Positive Patients Should Be Grouped as a Separate Category in the Classification of Juvenile Idiopathic Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :210
DOI: 10.1002/art.27979

Abstract Supplement

Meeting Menu

2010 ACR/ARHP