Article PDF


juvenile idiopathic arthritis, adults, polyarthritis, management tactics

Abstract views: 104
PDF Downloads: 41

How to Cite

Dzhus, M., Mostbauer, G., Karasevska, T., Shevchuk, M., & Kulik, M. (2019). СLINICAL AND LABORATORY DATA AND ALGORITHM OF MANAGEMENT OF ADULT PATIENTS WITH POLYARTICULAR VARIANT OF JUVENILE IDIOPATHIC ARTHRITIS. Medical Science of Ukraine (MSU), 15(3-4), 24-31. https://doi.org/10.32345/2664-4738.3-4.2019.04


Relevance. The polyarticular variant of juvenile idiopathic arthritis (JIA) is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses. At 18, patients go under the supervision of adult rheumatologists, often accompanied by loss of control of the disease due to insufficient compliance from both the patient and the physician. Today, there is no documented process for the transfer of patients from childhood to adulthood in Ukraine. Therefore, creating an algorithm for managing such patients is an urgent task.The polyarticular variant of JIA is a disease that begins in childhood and leads to joint damage and disability in adulthood with significant social losses.

 Objective of this study was to evaluate the clinical and laboratory status and to develop an algorithm for managing adult patients with polyarticular variant of JIA, depending on the detection of RF or/and A-CCP.

 Materials and methods. The study included 168 adult patients from different regions of Ukraine who were diagnosed with JIA in childhood between 1984 and 2014 without severe comorbidities.  Inclusion criteria were: 16 to 60 years old;  duration of the disease more than 3 years;  the presence of documentary evidence of childhood diagnosis of JIA (ambulatory card, hospital records). Among patients with JIA were identified 53 patients with polyarticular variant, of whom 42 or 25% - with RF (-) polyarthritis and 11 or 6.5% - with RF (+) polyarthritis. The disease activity was evaluated by DAS28 and JADAS-10. The questionaries SF-36, HAQ, TAS-20, PHQ-9 were analyzed and remote articular JADI-A and extra-articular JADI-E damages were evaluated. Statistical studies were performed using IBM SPPS Statistics version software, the results were considered to be reliable at 5% critical level (P <0.05). 

Results. The negative correlation of JADI-A and the patient's physical well-being PCS (r = -0.27, p <0.05) and physical functioning (r = -0.24, p <  0.05), pain intensity (r = -0.24, p <0.05), general health (r = -0.24, p <0.05), vital activity (r = -0,  19, p <0,05), social functioning (r = -0,27, p <0,05), mental health (r = -0,22, p <0,05) according to SF-36. The severity of extra-articular damages JADI-E correlated with PCS (r = -0.22, p <0.05) and physical functioning (r = -0.28, g  <0.05), pain intensity (r = -0.20, p <0.05), general health (r = -0.23, p <0.05), and mental health (r =  -0.23, p <0.05), but also had a positive rcorrelation with HAM-A (r = 0.25, p <0.05), depression scale (r = 0.28, p <0,  05) and PHQ-9 (r = 0.28, p <0.05).  Significantly lower level of physical health was established in patients who requires prosthetics (p <0.001) compared to those who did not need prosthetics. 

Conclusion. Based on the results obtained, algorithms for managing adult patients with JIA positive for RF or / and A-CCP were developed, depending on the detected articular and extra-articular damages and the need for prosthetics and the psychological status.

Article PDF


1. Dzhus M.B. The problem of transfer of the patient to juvenile rheumatoid arthritis from pediatric to adult rheumatologist // Ukr. Rheumatological Journal. 2015; 61 (3): 35-9. [in Ukrainian]. Mode access: http://www.rheumatology.kiev.ua/article/8178/problema-peredachi-xvorogo-na-yuvenilnij-revmatoidnij-artrit-vid-dityachogo-do-doroslogo-revmatologa
2. Dzhus M.B. Standards and recommendations for transitional care for young patients with juvenile onset of rheumatic disease (EULAR / PReS, November 2016) // Health of Ukraine. 2016; 6 (49): 54-5. [in Ukrainian]. Mode access: https://health-ua.com/article/5324-standarti-ta-rekomendatc-z-perehdno-dopomogi-patcntam-molodogo-vku-z-yuvenl
3. Povorozniuk V.V., Amosova K.M., Dzhus M.B. Age-specific features of bone mineral density in young women with juvenile idiopathic arthritis // Ukr. Rheumatological Journal. 2017; 69 (3): 22-6. [in Ukrainian]. Mode access: http://www.rheumatology.kiev.ua/article/10295/vikovi-osoblivosti-mineralnoi-shhilnosti-kistkovoi-tkanini-u-zhinok-molodogo-viku-z-yuvenilnim-idiopatichnim-artritom
4. Dzhus M.B., Marushko T.V., Mostbauer H.V., Ivashkivsky О.І., Kurylchyk I.V., Yegorova N.A., Nosovets О.К. Prediction of long-term effects of polyarticular variant of juvenile idiopathic arthritis // Medical Science of Ukraine. 2017; 13 (3-4): 28-37. [in Ukrainian]. https://doi.org/10.32345/2664-4738.3-4.2017.05
5. Dzhus M. Alexithymia and quality of life in adult patients with juvenile idiopathic arthritis // Archive of clinical medicine. 2018; 1 (24): 16-20. E201814 https://doi.org/10.21802/acm.2018.1.4
6. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001 / R. E. Petty, T. R. Southwood, P. Manners [et al.] // J. Rheumatol. 2004; 31 (2): 390-2. Mode access: https://www.researchgate.net/publication/8887745_International_League_of_Associations_for_Rheumatology_Classification_of_Juvenile_Idiopathic_Arthritis_Second_Revision_Edmonton_2001
7. Development and validation of a clinical index for assessment of long-term damage in juvenile idiopathic arthritis / S. Viola, E. Felici, S. Magni-Manzoni [et al.] // Arthritis Rheum. 2005; 52: 2092-102. https://doi.org/10.1002/art.21119
8. Converting modified health assessment questionnaire (HAQ), multidimensional HAQ, and HAQII scores into original HAQ scores using models developed with a large cohort of rheumatoid arthritis patients / J. Anderson, H. Sayles, J. R. Curtis // Arthritis Care Res. (Hoboken). 2010; 62 (10): 1481-8. https://doi.org/10.1002/ acr.20265
9. European guidance for the diagnosis and management of osteoporosis in postmenopausal women /J. A. Kanis, E. V. McCloskey, H. Johansson, [et al.] // Osteoporos. Int. 2012; 24: 23-57. https://doi.org/10.1007/s00198-012-2074-y
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.