Background: Knowledge of the long-term outcomes of patients with juvenile idiopathic arthritis (JIA) has evolved during the past decade. Recent studies, using standardized classification criteria, new and reliable outcome measures and improved methods of statistical analyses, show that outcomes are still less than ideal. Approximately half of all young adults with JIA have ongoing active disease and over one third experience detectable degrees of disability and organ damage. These patients also show a distinctive pattern of growth disturbances. Most patients with general growth failure have systemic or polyarticular disease: significant short stature (final height standard deviation score <–2) has been noted in 41% of patients with systemic JIA and in 11% of patients with polyarticular JIA. In contrast, localized growth disturbances can be seen in patients with oligoarthritis. Conclusions: Despite its name, JIA can be a lifelong disorder. With early and more widespread use of biological and other innovative therapies, however, outcomes for patients with JIA should improve further.

Keywords:
Juvenile idiopathic arthritis, Outcome, Bone, Growth failure
1.
Peterson LS, Mason T, Nelson AM, O’Fallon WM, Gabriel SE: Psychosocial outcomes and health status of adults who have had juvenile rheumatoid arthritis. Arthritis Rheum 1997;12:2235–2240.
2.
Ruperto N, Levinson JE, Ravelli A, Shear ES, Link Tague B, Murray K, Martini A, Giannini EH: Long-term health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. I. Outcome status. J Rheumatol 1997;24:945–951.
3.
Zak M, Pedersen FK: Juvenile chronic arthritis into adulthood: a long-term follow-up study. Rheumatol 2000;38:198–204.
4.
Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Cheang M: Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort. J Rheumatol 2002;29:1989–1999.
5.
Minden K, Niewerth M, Listing J, Biedermann T, Bollow M, Schöntube M, Zink A: Long-term outcome in patients with juvenile idiopathic arthritis. Arthritis Rheum 2002;46:2392–2401.
6.
Packham JC, Hall MA: Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology (Oxford) 2002;41:1428–1435.
7.
Flatø B, Lien G, Smerdel A, Vinje O, Dale K, Johnston V, Sørskaar D, Moum T, Ploski R, Førre Ø: Prognostic factors in juvenile rheumatoid arthritis: a case-control study revealing early predictors and outcome after 14.9 years. J Rheumatol 2003;30:386–393.
8.
Fantini F, Gerloni V, Gattinara M, Cimaz R, Arnoldi C, Lupi E: Remission in juvenile chronic arthritis: a cohort study of 683 consecutive cases with a mean 10 year followup. J Rheumatol 2003;30:579–584.
9.
Foster HE, Marshall N, Myers A, Dunkley P, Griffiths ID: Outcome in adults with juvenile idiopathic arthritis: a quality of life study. Arthritis Rheum 2003;48:767–775.
10.
Arkela-Kautiainen M, Haapasaari J, Kautiainen H, Vilkkumaa I, Mälkiä E, Leirisalo-Repo M: Favourable social functioning and health related quality of life of patients with JIA in early adulthood. Ann Rheum Dis 2005;64:875–880.
11.
Levinson JE, Wallace CA: Dismantling the pyramid. J Rheumatol 1992;19(suppl 33):6–10.
12.
French AR, Mason T, Nelson AM, O’Fallon WM, Gabriel SE: Increased mortality in adults with a history of juvenile rheumatoid arthritis: a population-based study. Arthritis Rheum 2001;44:523–527.
13.
Thomas E, Symmons DP, Brewster DH, Black RJ, Macfarlane GJ: National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study. J Rheumatol 2003;30:958–965.
14.
Minden K, Kiessling U, Listing J, Niewerth M, Döring E, Meincke J, Schöntube M, Zink A: Prognosis of patients with juvenile chronic arthritis and juvenile spondyloarthropathy. J Rheumatol 2000;27:2256–2263.
15.
Oen K, Reed M, Malleson PN, Cabral DA, Petty RE, Rosenberg AM, Cheang M: Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis. J Rheumatol 2003;30:832–840.
16.
Zak M, Hassager C, Lovell DJ, Nielsen S, Henderson CJ, Pedersen FK: Assessment of bone mineral density in adults with a history of juvenile chronic arthritis: a cross-sectional long-term followup study. Arthritis Rheum 1999;42:790–798.
17.
Haugen M, Lien G, Flatø B, Kvammen J, Vinje O, Sørskaar D, Førre O: Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm. Arthritis Rheum 2000;43:1504–1510.
18.
Bartram S, Foster H, Francis R: Bone mineral density and juvenile chronic arthritis: comment on the article by Zak et al. Arthritis Rheum 2000;43:710.
19.
French AR, Mason T, Nelson AM, Crowson CS, O’Fallon WM, Khosla S, Gabriel SE: Osteopenia in adults with a history of juvenile rheumatoid arthritis. A population based study. J Rheumatol 2002;29:1065–1070.
20.
Still GF. On a form of chronic joint disease in children. Am J Dis Child 1978;132:195–200 [reprinted from Medico-Chirurgical Transactions, 1897, vol 80].
21.
Simon D, Fernando C, Czernichow P, Prieur AM: Linear growth and final height in patients with systemic juvenile idiopathic arthritis treated with longterm glucocorticoids. J Rheumatol 2002;29:1296–1300.
22.
Lovell DJ, White PH: Growth and nutrition in juvenile rheumatoid arthritis; in Woo P, White PH, Ansell BM (eds): Pediatric Rheumatology Update. Oxford, Oxford University Press, 1990, pp 47–56.
23.
Gäre BA, Fasth A: The natural history of juvenile chronic arthritis: a population based cohort study. II. Outcome. J Rheumatol 1995;22:308–319.
24.
Zak M, Müller J, Karup Pedersen F: Final height, armspan, subischial leg length and body proportions in juvenile chronic arthritis. A long-term follow-up study. Horm Res 1999;52:80–85.
25.
Saurenmann RK, Levin AV, Feldman BM, Rose JB, Laxer RM, Schneider R, Silverman ED: Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum 2007;56:647–657.
26.
Minden K: Prognosis of rheumatic diseases in children and adolescents [in German]. Kinder- und Jugendarzt 2008;8:258–266.
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2009
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