Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study

dc.contributor.authorConsolaro, Alessandro
dc.contributor.authorGiancane, Gabriella
dc.contributor.authorAlongi, Alessandra
dc.contributor.authorvan Dijkhuizen, Evert Hendrik Pieter
dc.contributor.authorAggarwal, Amita
dc.contributor.authorAl-Mayouf, Sulaiman M.
dc.contributor.authorBovis, Francesca
dc.contributor.authorDe Inocencio, Jaime
dc.contributor.authorDemirkaya, Erkan
dc.contributor.authorFlato, Berit
dc.contributor.authorFoell, Dirk
dc.contributor.authorGaray, Stella Maris
dc.contributor.authorLazar, Calin
dc.contributor.authorLovell, Daniel J.
dc.contributor.authorMontobbio, Carolina
dc.contributor.authorMiettunen, Paivi
dc.contributor.authorMihaylova, Dimitrina
dc.contributor.authorNielsen, Susan
dc.contributor.authorOrban, Ilonka
dc.contributor.authorRumba-Rozenfelde, Ingrida
dc.contributor.authorMagalhaes, Claudia Saad [UNESP]
dc.contributor.authorShafaie, Nahid
dc.contributor.authorSusic, Gordana
dc.contributor.authorTrachana, Maria
dc.contributor.authorWulffraat, Nico
dc.contributor.authorPistorio, Angela
dc.contributor.authorMartini, Alberto
dc.contributor.authorRuperto, Nicolino
dc.contributor.authorRavelli, Prof Angelo
dc.contributor.authorAbdwani, Reem
dc.contributor.authorAghighi, Yahya
dc.contributor.authorAiche, Maya-Feriel
dc.contributor.authorAilioaie, Constantin
dc.contributor.authorAyaz, Nuray Aktay
dc.contributor.authorAl-Abrawi, Safiya
dc.contributor.authorAlexeeva, Ekaterina
dc.contributor.authorAnton, Jordi
dc.contributor.authorApostol, Adriana
dc.contributor.authorArguedas, Olga
dc.contributor.authorAvcin, Tadej
dc.contributor.authorBarone, Patrizia
dc.contributor.authorBerntson, Lillemor
dc.contributor.authorLucica Boteanu, Alina
dc.contributor.authorBoyko, Yaryna
dc.contributor.authorBurgos-Vargas, Ruben
dc.contributor.authorCalvo Penades, Inmaculada
dc.contributor.authorChedeville, Gaelle
dc.contributor.authorCimaz, Rolando
dc.contributor.authorCivino, Adele
dc.contributor.authorConsolini, Rita
dc.contributor.authorConstantin, Tamas
dc.contributor.authorCuttica, Ruben
dc.contributor.authorDallos, Tomas
dc.contributor.authorMartin, Neil
dc.contributor.authorManzoni, Silvia Magni
dc.contributor.authorDe Cunto, Carmen
dc.contributor.authorDolezalova, Pavla
dc.contributor.authorEkelund, Maria
dc.contributor.authorEl Miedany, Yasser
dc.contributor.authorEspada, Graciela
dc.contributor.authorChristensen, Anne Estmann
dc.contributor.authorFoeldvari, Ivan
dc.contributor.authorGallizzi, Romina
dc.contributor.authorGanser, Gerd
dc.contributor.authorGerloni, Valeria
dc.contributor.authorHaas, Johannes-Peter
dc.contributor.authorHarel, Liora
dc.contributor.authorHarjacek, Miroslav
dc.contributor.authorHashad, Soad
dc.contributor.authorHerlin, Troels
dc.contributor.authorHerrera, Cristina
dc.contributor.authorHofer, Michael
dc.contributor.authorHolzinger, Dirk
dc.contributor.authorHorneff, Gerd
dc.contributor.authorHuppertz, Hans-Iko
dc.contributor.authorIagaru, Nicolae
dc.contributor.authorEstrella, Amparo Ibanez
dc.contributor.authorIoseliani, Maka
dc.contributor.authorJoos, Rik
dc.contributor.authorOliveira, Sheila Knupp
dc.contributor.authorKamphuis, Sylvia
dc.contributor.authorKasapcopur, Ozgur
dc.contributor.authorKatsicas, Maria Martha
dc.contributor.authorKhubchandani, Raju
dc.contributor.authorKondi, Anuela
dc.contributor.authorKroger, Liisa
dc.contributor.authorLa Torre, Francesco
dc.contributor.authorLaday, Matilda
dc.contributor.authorLahdenne, Pekka
dc.contributor.authorMaggio, Maria Cristina
dc.contributor.authorMagnolia, Maria Greca
dc.contributor.authorMalagon, Clara
dc.contributor.authorMalin, Merja
dc.contributor.authorMartino, Silvana
dc.contributor.authorMelo-Gomes, Jose Antonio
dc.contributor.authorMesa-del-Castillo, Pablo
dc.contributor.authorMilitaru, Andrea
dc.contributor.authorMinden, Kirsten
dc.contributor.authorMiniaci, Angela
dc.contributor.authorMoradinejad, Mohammad Hasan
dc.contributor.authorAyala, Zoilo Morel
dc.contributor.authorNikishina, Irina
dc.contributor.authorNorambuena, Ximena
dc.contributor.authorNordal, Ellen Berit
dc.contributor.authorPagava, Karaman
dc.contributor.authorPanaviene, Violeta
dc.contributor.authorPastore, Serena
dc.contributor.authorPieropan, Sara
dc.contributor.authorPodda, Rosa Anna
dc.contributor.authorPruunsild, Chris
dc.contributor.authorPutto-Laurila, Anne
dc.contributor.authorQuartier, Pierre
dc.contributor.authorRemesal, Agustin
dc.contributor.authorRigante, Donato
dc.contributor.authorRingold, Sarah
dc.contributor.authorRutkowska-Sak, Lidia
dc.contributor.authorRygg, Marite
dc.contributor.authorSaurenmann, Rotraud Katharina
dc.contributor.authorSawhney, Sujata
dc.contributor.authorScott, Christiaan
dc.contributor.authorShiari, Reza
dc.contributor.authorSmolewska, Elzbieta
dc.contributor.authorSozeri, Betul
dc.contributor.authorSwart, Joost Frans
dc.contributor.authorSztajnbok, Flavio
dc.contributor.authorTorcoletti, Marta
dc.contributor.authorTsitsami, Elena
dc.contributor.authorTzaribachev, Nikolay
dc.contributor.authorUnsal, Erbil
dc.contributor.authorUziel, Yosef
dc.contributor.authorVahasalo, Paula
dc.contributor.authorVarbanova, Boriana
dc.contributor.authorVargova, Veronika
dc.contributor.authorVesely, Richard
dc.contributor.authorVijatov-Djuric, Gordana
dc.contributor.authorVilaiyuk, Soamarat
dc.contributor.authorVojinovic, Jelena
dc.contributor.authorVougiouka, Olga
dc.contributor.authorWeiss, Pamela
dc.contributor.authorWoute, Carine
dc.contributor.authorPaediat Rheumatology Int Trials Or
dc.contributor.institutionUniv Genoa
dc.contributor.institutionWilhelmina Childrens Hosp
dc.contributor.institutionSanjay Gandhi Postgrad Inst Med Sci
dc.contributor.institutionUniv Hosp 12 Octubre
dc.contributor.institutionAlfaisal Univ
dc.contributor.institutionWestern Univ Childrens Hosp
dc.contributor.institutionOslo Univ Hosp
dc.contributor.institutionUniv Oslo
dc.contributor.institutionUniv Hosp Munster
dc.contributor.institutionHosp Sor Maria Ludovica
dc.contributor.institutionBucharest Emergency Hosp
dc.contributor.institutionChildrens Emergency Hosp
dc.contributor.institutionCincinnati Childrens Hosp Med Ctr
dc.contributor.institutionAlberta Childrens Prov Gen Hosp
dc.contributor.institutionSofiamed
dc.contributor.institutionRigshosp
dc.contributor.institutionNatl Inst Rheumatism & Physiotherapy
dc.contributor.institutionUniv Latvia
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.contributor.institutionShariati Hosp
dc.contributor.institutionInst Rheumatol Belgrade
dc.contributor.institutionThessaloniki Univ
dc.date.accessioned2019-10-05T16:54:20Z
dc.date.available2019-10-05T16:54:20Z
dc.date.issued2019-04-01
dc.description.abstractBackground To our knowledge, the characteristics and burden of childhood arthritis have never been studied on a worldwide basis. We aimed to investigate, with a cross-sectional study, the prevalence of disease categories, treatment methods, and disease status in patients from across different geographical areas and from countries with diverse wealth status. Methods In this multinational, cross-sectional, observational cohort study, we asked international paediatric rheumatologists from specialised centres to enrol children with a diagnosis of juvenile idiopathic arthritis, according to International League of Associations for Rheumatology criteria, who were seen consecutively for a period of 6 months. Each patient underwent retrospective and cross-sectional assessments, including measures of disease activity and damage and questionnaires on the wellbeing and quality of life of the children. We qualitatively compared the collected data across eight geographical areas, and we explored an association between disease activity and damage and a country's gross domestic product (GDP) with a multiple logistic regression analysis. Findings Between April 4, 2011, and Nov 21, 2016, 9081 patients were enrolled at 130 centres in 49 countries, grouped into eight geographical areas. Systemic arthritis (125 [33.0%] of 379 patients) and enthesitis-related arthritis (113 [29.8%] of 379) were more common in southeast Asia, whereas oligoarthritis was more prevalent in southern Europe (1360 [56.7%] of 2400) and rheumatoid factor-negative polyarthritis was more frequent in North America (165 [31.5%] of 523) than in the other areas. Prevalence of uveitis was highest in northern Europe (161 [19.1%] of 845 patients) and southern Europe (450 [18.8%] of 2400) and lowest in Latin America (54 [6.4%] of 849), Africa and Middle East (71 [5.9%] of 1209), and southeast Asia (19 [5.0%] of 379). Median age at disease onset was lower in southern Europe (3.5 years, IQR 1.9-7.3) than in other regions. Biological, disease-modifying antirheumatic drugs were prescribed more frequently in northern Europe and North America than in other geographical settings. Patients living in countries with lower GDP had greater disease activity and damage than those living in wealthier countries. Damage was associated with referral delay. Interpretation Our study documents a variability in prevalence of disease phenotypes and disparities in therapeutic choices and outcomes across geographical areas and wealth status of countries. The greater disease burden in lowerresource settings highlights the need for public health efforts aimed at improving equity in access to effective treatments and care for juvenile idiopathic arthritis. Copyright (C) 2019 Elsevier Ltd. All rights reserved.en
dc.description.affiliationUniv Genoa, Ist Giannina Gaslini, IRCCS, Clin Paediat & Rheumatol, Genoa, Italy
dc.description.affiliationUniv Genoa, Ist Giannina Gaslini, IRCCS, Epidemiol & Biostat Serv, Genoa, Italy
dc.description.affiliationUniv Genoa, Ist Giannina Gaslini, IRCCS, Sci Directory, Genoa, Italy
dc.description.affiliationUniv Genoa, PRINTO, IRCCS, Ist Giannina Gaslini, Genoa, Italy
dc.description.affiliationUniv Genoa, Dept Neurosci Rehabil Ophthalmol Genet & Maternal, Genoa, Italy
dc.description.affiliationWilhelmina Childrens Hosp, Dept Pediat Immunol & Rheumatol, Utrecht, Netherlands
dc.description.affiliationSanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh, India
dc.description.affiliationUniv Hosp 12 Octubre, Dept Pediat Rheumatol, Madrid, Spain
dc.description.affiliationAlfaisal Univ, Dept Pediat Rheumatol, King Faisal Specialist Hosp, Riyadh, Saudi Arabia
dc.description.affiliationAlfaisal Univ, Res Ctr, Riyadh, Saudi Arabia
dc.description.affiliationWestern Univ Childrens Hosp, Hlth Sci Ctr, London, ON, Canada
dc.description.affiliationOslo Univ Hosp, Dept Rheumatol, Oslo, Norway
dc.description.affiliationOslo Univ Hosp, Med Fac, Oslo, Norway
dc.description.affiliationUniv Oslo, Oslo, Norway
dc.description.affiliationOslo Univ Hosp, Norwegian Natl Advisory Unit Rheumat Dis Children, Oslo, Norway
dc.description.affiliationUniv Hosp Munster, Dept Pediat Rheumatol & Immunol, Munster, Germany
dc.description.affiliationHosp Sor Maria Ludovica, Rheumatol Serv, La Plata, Buenos Aires, Argentina
dc.description.affiliationBucharest Emergency Hosp, Cluj Napoca, Romania
dc.description.affiliationChildrens Emergency Hosp, Cluj Napoca, Romania
dc.description.affiliationCincinnati Childrens Hosp Med Ctr, Div Rheumatol, Cincinnati, OH 45229 USA
dc.description.affiliationAlberta Childrens Prov Gen Hosp, Div Pediat Rheumatol, Dept Pediat, Calgary, AB, Canada
dc.description.affiliationSofiamed, Pediat Dept, Sofia, Bulgaria
dc.description.affiliationRigshosp, Juliane Marie Ctr, Paediat Rheumatol Unit, Copenhagen, Denmark
dc.description.affiliationNatl Inst Rheumatism & Physiotherapy, Clin Immunol Adult & Paediat Rheumatol Dept, Budapest, Hungary
dc.description.affiliationUniv Latvia, Pediat Dept, Riga, Latvia
dc.description.affiliationUniv Latvia, Univ Childrens Hosp, Riga, Latvia
dc.description.affiliationUniv Estadual Paulista, Botucatu Fac Med, Botucatu, SP, Brazil
dc.description.affiliationShariati Hosp, Rheumatol Res Ctr, Dept Pediat & Rheumatol, Tehran, Iran
dc.description.affiliationInst Rheumatol Belgrade, Div Pediat Rheumatol, Belgrade, Serbia
dc.description.affiliationThessaloniki Univ, Dept Pediat 1, Hippokrat Gen Hosp, Sch Med, Thessaloniki, Greece
dc.description.affiliationUnespUniv Estadual Paulista, Botucatu Fac Med, Botucatu, SP, Brazil
dc.description.sponsorshipIRCCS Istituto Giannina Gaslini
dc.format.extent255-263
dc.identifierhttp://dx.doi.org/10.1016/S2352-4642(19)30027-6
dc.identifier.citationLancet Child & Adolescent Health. Oxford: Elsevier Sci Ltd, v. 3, n. 4, p. 255-263, 2019.
dc.identifier.doi10.1016/S2352-4642(19)30027-6
dc.identifier.issn2352-4642
dc.identifier.lattes7098310008371632
dc.identifier.orcid0000-0002-7631-7093
dc.identifier.urihttp://hdl.handle.net/11449/186676
dc.identifier.wosWOS:000461198100020
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofLancet Child & Adolescent Health
dc.rights.accessRightsAcesso aberto
dc.sourceWeb of Science
dc.titlePhenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort studyen
dc.typeArtigo
dcterms.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dcterms.rightsHolderElsevier B.V.
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