Jüvenil idiyopatik artritli hastalarda tek merkez deneyimi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Necmettin Erbakan Üniversitesi Tıp Fakültesi Çocuk Nefrolojisi Polikliniğinde Ocak 2010 ve Aralık 2021 tarihleri arasında takip edilmiş olan jüvenil idiyopatik artritli (JİA) hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, JİA alt grup dağılımları, klinik özellikleri, laboratuvar bulguları, aldığı tedaviler incelendi. İstatistiksel analizler için SPSS 22.0 programı kullanıldı ve p<0,05 olması anlamlı kabul edildi.
Çalışmaya 88 hasta dahil edildi. Hastaların, 36’sı (%40,9) erkek, 52’si (%59,1) kız idi. Erkek/kız oranı 0,69 olarak saptandı. Hastaların yaş ortalaması 97,67±52,62 ay, yaş ortancası 96 (min: 9 – mak: 192) aydı. Hastaların, JİA alt grup dağılımına baktığımızda 31’i (%35,2) sistemik, 35’i (%39,8) oligoartiküler, 19’u (%21,6) poliartiküler, biri (%1,1) psöriatik artrit ve ikisi (%2,3) entezit ilişkili artrit olarak saptandı. Hastaların başvuru anındaki semptom ve bulguları incelendiğinde; hastaların tamamında (%100) artrit saptandı. Hastaların 36’sında (%40,9) ateş öyküsü vardı. Bu hastaların 31’i (%86) sistemik JİA idi. Hastaların 19’unda (%21,6) organomegali (hepatomegali ve/veya splenomegali) olduğu görüldü. Yirmi hastada (%22,7) lenfadenopati mevcuttu. Hastaların 11’inde (%12,5) ilk tanı anında ve/veya takibinde üveit olduğu saptandı. Hastaların 80’ine (%90,9) ekokardiyografi yapıldığı görüldü. Ekokardiyografi yapılan 70 hastanın (%87,5) normal olarak değerlendirildiği görüldü. On hastada (%12,5) ise mitral kapak prolapsusu, mitral yetmezlik veya pulmoner stenoz gibi patolojik bulgular saptandığı görüldü. Hastaların 45’inde (%51,1) anti nükleer antikor (ANA) testi pozitif saptandı. Hastaların diğer laboratuvar bulguları incelendiğinde, eritrosit sedimatasyon hızı (ESH) ortalaması 52,7±33,68 mm/saat, ferritin ortalaması 901,69±2007,89 mg/dl, c reaktif protein (CRP) ortalaması 71,79±67,4 mg/L olarak saptanmıştır.
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Hastalara verilen tedaviler incelendiğinde, toplam 42 (%52,3) olguda kortikosteroid, 75 (%85,2) olguda metotreksat, sekiz (%9,1) olguda biyolojik ajan kullanıldığı saptandı.
JİA, çocukluk çağının en sık görülen kronik romatizmal hastalığıdır ve çocukluk döneminde fonksiyon kayıplarının önemli nedenlerindendir. JİA’da erken tanı koyup, gerekli tedaviyi başlamak, hastalığın kontrol altına alınmasında ve fonksiyon kayıplarının önlenmesinde önem arz etmektedir. Literatür incelendiğinde JİA alt grupları coğrafi bölgelere göre değişik oranlarda dağılım gösterdiği, gelişmekte olan tedavi yöntemleriyle de fonksiyon kayıplarının azaldığı görülmektedir.
Çalışmamızda hastanemizde takip edilen JİA hastalarından yola çıkarak bölgemizdeki JİA hastalarının demografik, klinik özelliklerini, alt grup dağılımlarını, verilen tedavileri ve hastaların uzun dönem takiplerinde ortaya çıkan komplikasyonları inceledik. Benzer çalışmaların farklı bölgelerde yapılmasıyla farkındalığın artmasını, JİA dağılımını ve hasta profilinin daha iyi anlaşılmasını sağlayacağını düşünmekteyiz.
Medical records of the patients diagnosed with juvenile idiopathic arthritis (JIA) in Pediatric Nephrology Outpatient Clinic, Necmettin Erbakan University between January 2010 and December 2021 were retrospectively evaluated. Patients’demographic characteristics, distribution by JIA subgroup, clinical characteristics, laboratory findings, and treatments received were examined. For statistical analyses, SPSS 22.0 program was used and a p<0.05 was considered significant. A total of 88 patients were included in the study. Of the patients, 36 (40.9%) were male and 52 (59.1%) female. Male/female ratio was found to be 0.69. Patients’ mean age was 97.67±52.62 months and median age was 96 (min: 9 – max: 192) months. In regard to distribution by JIA subgroups, it was found that 35 (39.8%) were oligoarticular, 31 (35.2%) systemic, 19 (21.6%) polyarticular, two (2.3%) enthesitis-related, and one (1.1%) psoriatic arthritis. When admission symptoms and signs were examined, all patients (100%) were determined to have arthritis. Of the patients, 36 (40.9%) had history of fever, 31 (86%) of which had systemic JIA. Of the patients, 19 (21.6%) were found to have organomegaly (hepatomegaly and/or splenomegaly). Twenty patients (22.7%) had lymphadenopathy. Of the patients, 11 (12.5%) were found to have uveitis on admission and/or during follow-up. Of the patients, 80 (90.9%) were observed to have had echocardiography. It was observed that, of the patients undergone echocardiography, 70 (87.5%) were determined to have a normal result, whereas 10 patients (12.5%) were found to have some pathological findings, including prolapsed mitral valve, mitral insufficiency or pulmonary stenosis. Of the patients, 45 (51.1%) were tested positive for antinuclear antibody (ANA). When other laboratory findings were examined, it was observed that mean erythrocyte sedimentation rate (ESR) was 52.7±33.68 mm/hour, mean ferritin level 901.69±2007.89 mg/dl, and mean c-reactive protein level 71.79±67.4 mg/L. vii In regard to treatments given, it was determined that corticosteroids were used in a total of 42 (52.3%) patients, methotrexate in 75 (85.2%) patients, and biological agents in eight (9.1%) patients. JIA is the most common chronic rheumatic disease of childhood and one of important causes of loss of function during childhood. For JIA, early diagnosis, followed by initiation of necessary treatment, is of vital importance in controlling the disease and preventing loss of function. Literature review reveals that JIA subgroups have varying distribution rates across different geographic areas and that loss of function has reduced with developing treatment methods. In our study, based upon patients with JIA being followed-up in our hospital, we examined demographic and clinical characteristics, distribution by subgroups, treatments received and long-term complications in patients with JIA from our region. We are in thought of that conduction of similar studies in different areas will increase the awareness and will provide a better understanding of JIA distribution and patient profiles.
Medical records of the patients diagnosed with juvenile idiopathic arthritis (JIA) in Pediatric Nephrology Outpatient Clinic, Necmettin Erbakan University between January 2010 and December 2021 were retrospectively evaluated. Patients’demographic characteristics, distribution by JIA subgroup, clinical characteristics, laboratory findings, and treatments received were examined. For statistical analyses, SPSS 22.0 program was used and a p<0.05 was considered significant. A total of 88 patients were included in the study. Of the patients, 36 (40.9%) were male and 52 (59.1%) female. Male/female ratio was found to be 0.69. Patients’ mean age was 97.67±52.62 months and median age was 96 (min: 9 – max: 192) months. In regard to distribution by JIA subgroups, it was found that 35 (39.8%) were oligoarticular, 31 (35.2%) systemic, 19 (21.6%) polyarticular, two (2.3%) enthesitis-related, and one (1.1%) psoriatic arthritis. When admission symptoms and signs were examined, all patients (100%) were determined to have arthritis. Of the patients, 36 (40.9%) had history of fever, 31 (86%) of which had systemic JIA. Of the patients, 19 (21.6%) were found to have organomegaly (hepatomegaly and/or splenomegaly). Twenty patients (22.7%) had lymphadenopathy. Of the patients, 11 (12.5%) were found to have uveitis on admission and/or during follow-up. Of the patients, 80 (90.9%) were observed to have had echocardiography. It was observed that, of the patients undergone echocardiography, 70 (87.5%) were determined to have a normal result, whereas 10 patients (12.5%) were found to have some pathological findings, including prolapsed mitral valve, mitral insufficiency or pulmonary stenosis. Of the patients, 45 (51.1%) were tested positive for antinuclear antibody (ANA). When other laboratory findings were examined, it was observed that mean erythrocyte sedimentation rate (ESR) was 52.7±33.68 mm/hour, mean ferritin level 901.69±2007.89 mg/dl, and mean c-reactive protein level 71.79±67.4 mg/L. vii In regard to treatments given, it was determined that corticosteroids were used in a total of 42 (52.3%) patients, methotrexate in 75 (85.2%) patients, and biological agents in eight (9.1%) patients. JIA is the most common chronic rheumatic disease of childhood and one of important causes of loss of function during childhood. For JIA, early diagnosis, followed by initiation of necessary treatment, is of vital importance in controlling the disease and preventing loss of function. Literature review reveals that JIA subgroups have varying distribution rates across different geographic areas and that loss of function has reduced with developing treatment methods. In our study, based upon patients with JIA being followed-up in our hospital, we examined demographic and clinical characteristics, distribution by subgroups, treatments received and long-term complications in patients with JIA from our region. We are in thought of that conduction of similar studies in different areas will increase the awareness and will provide a better understanding of JIA distribution and patient profiles.
Açıklama
Anahtar Kelimeler
Jüvenil idiyopatik artrit, Oligoartrit, Poliartrit, Üveit, Juvenile idiopathic arthritis, Oligoarthritis, Polyarthritis, Uveitis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çeliktaş, H. (2023). Jüvenil idiyopatik artritli hastalarda tek merkez deneyimi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
