Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


A Cross Sectional Study of Juvenile Idiopathic Arthritis in African American Children Compared with Non-Hispanic White Children in the Childhood Arthritis and Rheumatology Research Alliance Registry.

Prahalad1,  Sampath, Angeles-Han1,  Sheila, Pelajo2,  Christina F., Kennedy1,  Christine W., Ponder1,  Lori, Lopez-Benitez2,  Jorge M., Vogler1,  Larry B.

Emory University School of Medicine, Atlanta, GA
Tufts Medical Center, Boston, MA
Stanford

Background/Purpose:

JIA is the most common chronic childhood arthropathy with an estimated prevalence of ~1/1000 children under 16 years of age. Although JIA affects male and female children of all races, there are only few epidemiologic investigations in small cohorts that describe the characteristics of JIA in African American (AA) children. Our objective is to compare disease characteristics between AA and Non-Hispanic White (NHW) children with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, the largest multicenter observational Registry.

Methods:

Children with JIA from pediatric rheumatology clinics in the US were enrolled in the CARRAnet Registry from May 2010 until June 2011. Demographic and disease-related data were collected from time of diagnosis to enrollment visit. Children reporting Hispanic ethnicity and those who categorized themselves as more than one race were excluded. Non-Hispanic African American children with JIA were compared with Non-Hispanic White children with JIA. Nominal variables were compared using Chi square or Fisher's exact tests. Continuous variables were compared using Student's T test.

Results:

In all, 2167 NHW children and 125 AA children were analyzed. Table 1 shows demographic and disease characteristics of NHW and AA children. AA children with JIA were significantly older at disease onset, presentation and enrollment less likely to be female and have a family history of autoimmunity. There were significant differences in the frequencies of different JIA subtypes between AA and NHW children. AA children were more likely to have RF+ polyarticular JIA and less likely to have psoriatic JIA or uveitis. Laboratory variables demonstrated that AA children with JIA were less likely to have positive ANA and HLA B27, and more likely to have confirmed RF and CCP compared to NHW children. The differences in age of onset between AA and NHW children persisted after excluding polyarticular RF+ JIA (6.0 vs 8.4 years; p <2.5×10-6).

Table 1. Characteristics of NHW and AA children with JIA*

 NHWAAp
Total Number2167125 
Age at baseline visit (mean ±SD)11.4 ± 4.712.8 ± 4.4<7 × 10-9
Age at symptom onset (mean ± SD)6.2 ± 4.38.8 ± 4.3<4 × 10-9
Age first seen by pediatric rheumatologist (mean ±SD)7.1 ± 4.59.5 ± 4.50.0009
Gender: females1594 (73)78 (62)0.006
Income..<1 × 10-7
<U$49,999475 (26)60 (63) 
U$50,000- 99,999670 (36)29 (30) 
>U$100,000710 (38)6 (6) 
Health insurance2116 (99)117 (99)0.66
Family history of autoimmunity577 (27)22 (18)0.03
JIA subtype.. 
ERA223 (10)7 (10)0.14
Oligoarticular extended193 (9)5 (4)0.02med
Oligoarticular persistent593 (27)22 (18)0.06
Polyarticular RF-660 (31)27 (22)0.03
Polyarticular RF+108 (5)24 (19)1 × 10-7
Psoriatic150 (7)2 (2)0.02
Systemic-onset168 (8)20 (16)0.001
Undifferentiated62 (3)6 (5)ns
Uveitis258 (12)5 (4)0.008
Measures of disease.. 
CHAQ (mean)0.340.580.0004
MD Global (mean)1.522.55<8 × 10-5
Laboratory tests.. 
Positive ANA970 (50)36(34)0.001
Positive HLA-B27168 (14)5 (6)0.05
Confirmed RF positive64 (9)17(33)1 × 10-7
Anti-CCP positive61 (8)17(27)1 × 10-7
Treatment...
Use of systemic steroids1456 (68)83 (70)0.64
Use of DMARD ever1675 (78)91 (76)0.66
Use of biologic ever967 (45)67 (55)0.03
* All values are N(%) of those tested/reporting data for particular variables, except as indicated.

Conclusion:

This is the largest described cohort of AA children with JIA, and we confirm reports of differences in disease characteristics reported in smaller earlier studies. Compared to non-Hispanic White children with JIA, African American children with JIA demonstrate significant differences in disease characteristics. Specifically they are older at disease onset, are more likely to have RF/CCP positive polyarthritis and are less likely to have uveitis, psoriatic arthritis, ANA or HLA B27. These observations support that the phenotype of JIA is different in African American children with JIA.

To cite this abstract, please use the following information:
Prahalad, Sampath, Angeles-Han, Sheila, Pelajo, Christina F., Kennedy, Christine W., Ponder, Lori, Lopez-Benitez, Jorge M., et al; A Cross Sectional Study of Juvenile Idiopathic Arthritis in African American Children Compared with Non-Hispanic White Children in the Childhood Arthritis and Rheumatology Research Alliance Registry. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :281
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