Outcome in patients with enthesitis related arthritis (ERA): Juvenile Arthritis Damage Index (JADI) and functional status

Abstract

Background: Data on outcome of ERA is scarce; there is lack of well-accepted tools. JADI is a newly described outcome measure in JIA that has not been evaluated in ERA. We studied outcome in ERA using JADI; correlated it with traditional outcome measures. Methods: We studied 49 consecutive patients of ERA with age ≥ 5 years; duration ≥ 1 year. Along with JADI, we recorded enthesitis, lumbar spinal anterior flexion by modified Schober's method, presence of inflammatory backache, loss of school years, HAQ-S, growth; pubertal delay. Parent's/patient's; physician's global assessments on 00 mm visual analogue scale. Results: The median age was 8.0 (0.7) years; the median duration of disease was 6.0 (. 7) years. All the patients were male; half (5.%) were HLA B 7 positive. Fourteen had decreased anterior lumbar flexion movement; had inflammatory backache. Active enthesitis was present in 6.%. Functionally, mild, moderate; severe disability was seen in 8.4%, 4.7%; 4.% respectively. Sixty five percent of patients lost education years. Twenty-eight patients had damaged joints with median of .0 joints (0.9). Seventeen patients (4.7%) had damaged joints in JADI-A score with a median of .0 (0.). Growth failure was the commonest extra articular damage (8.%) in JADI-E. JADI correlated with HAQ-S, parent's or patient's; physician's global assessment (p < 0.0). Limitation of spinal mobility had high correlation with HAQ-S; correlation with JADI-A was low. Conclusion: Three fourth of the ERA patients had functional limitations. Half of the patients had damaged joints. Even though JADI correlated well with traditional outcome measures, it underestimates joint damage, does not assess enthesitis; spinal limitation which affect functional status in ERA. Inclusion of these may make it more useful for ERA.