LONG-TERM HEALTH OUTCOMES AND QUALITY-OF-LIFE IN AMERICAN AND ITALIANINCEPTION COHORTS OF PATIENTS WITH JUVENILE RHEUMATOID-ARTHRITIS .2. EARLY PREDICTORS OF OUTCOME

Objective. To determine whether demographic, clinical, and immunogenet ic variables measurable during the first 6 months of illness predict l ongterm health outcomes and quality of life in patients with juvenile rheumatoid arthritis (JTCA). Methods. Patient eligibility criteria: (1 ) first examined in our units between 1958 and 1990 within 6 months of onset of symptoms, (2) diagnosis of JRA by American College of Rheuma tology criteria; (3) disease duration of at least 5 years at the time of assessment of outcome. instruments used: (1) the Health Assessment Questionnaire (HAQ, short form), or Childhood HAQ (CHAQ) to measure di sability (0-3 scale), (2) pain, and (3) parental assessment of overall well being, each scored on a 15 cm visual analog scale; (4) the Quali ty of Life Scales (QOLS) (adults only), Independent variables that sho wed significant results using univariate tests underwent multiple logi stic regression analysis. Results, 227 patients were available for ana lysis. Mean duration oi disease at lime of assessment of outcome was 1 5 years (range 5.3-36.1). Univariate tests allowed 11 variables for di sability, 9 for pain, 7 or overall well being, and 4 for POL into the multivariate analysis. I-The best predictor of higher disability was t he articular severity score (odds ratio, OR, 5.69) while antinuclear a ntibody positivity foretold less disability (OR 0.29). HLA-DR5 positiv ity conferred the greatest risk for pain (OR 3.34), while HLA-B5, DR3, and C3 were protective (OR 0.25, 0.28, 0.33, respectively). Early han d involvement was the strongest predictor of poorer overall well being (OR 8.75), Only the erythrocyte sedimentation rate was predictive of future QOL, but the model yielded a low C statistic (< 70%) and the OR 95% confidence limits were extreme (OR 9.77; 95% confidence interval, 1.22-77.8). Conclusion. Clinical and immunogenetic variables measurab le within 6 months of onset of JRA can be used to predict future disab ility, pain, and well being. QOL appears more difficult tu forecast, p erhaps due to the multiple domains that make up this outcome, Further study is needed to identify other genetic and laboratory factors that predict outcome in JRA with rearer precision.