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.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.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.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 lower-resource settings highlights the need
for public health efforts aimed at improving equity in access to effective treatments
and care for juvenile idiopathic arthritis.IRCCS Istituto Giannina Gaslini.
