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Rheumatology Advance Access originally published online on April 16, 2008
Rheumatology 2008 47(7):991-995; doi:10.1093/rheumatology/ken085
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© 2008 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Association between duration of symptoms and severity of disease at first presentation to paediatric rheumatology: results from the Childhood Arthritis Prospective Study

N. Adib1,*, K. Hyrich1,*, J. Thornton1, M. Lunt1, J. Davidson2, J. Gardner-Medwin2, H. Foster3, E. Baildam4, L. Wedderburn5 and W. Thomson1

1Arthritis Research Campaign Epidemiology Unit, University of Manchester, Manchester, 2Department of Child Health, Royal Hospital for Sick Children, Glasgow, 3Department of Rheumatology, Medical School, Newcastle upon Tyne, 4Department of Rheumatology, Royal Liverpool Children's Hospital, Alder Hey, Liverpool and 5Rheumatology Unit, Institute of Child Health, London, UK.

Correspondence to: K. Hyrich, Arthritis Research Campaign Epidemiology Unit, University of Manchester, Oxford Road, Manchester M13 9PT, UK. E-mail: kimme.hyrich{at}manchester.ac.uk


  Abstract

Objectives. To study the association between disease severity at first presentation to paediatric rheumatology (PRh) and length of time since symptom onset in children recruited to the Childhood Arthritis Prospective Study.

Methods. Children ≤16 yrs with inflammatory arthritis persisting ≥2 weeks were recruited from five UK hospitals. Data including demographics, disease features, Childhood Health Assessment Questionnaire (CHAQ), physician and parent global assessment and blood tests were collected at the first appointment with PRh (baseline). The association between symptom duration (defined as time from first reported symptom onset to presentation at PRh) and baseline disease characteristics was evaluated using non-parametric descriptive statistics and multivariable logistic regression analyses.

Results. Five hundred and seven children (65% female) were included: median age at onset was 6.8 yrs. Two hundred and thirty-three had oligoarthritis, 68 had RF-negative polyarthritis, 27 had systemic onset arthritis and 29 had arthritis that was not JIA. The median symptom duration was 4.6 months. Median symptom duration was shortest for children presenting with systemic arthritis (1.6 months) and longest for those with PsA (8.6 months). Children with a longer duration of symptoms were older and had higher median active joint counts but lower median ESR. Symptom duration did not correlate with CHAQ score at presentation.

Conclusions. Children who have systemic arthritis had the shortest delay to PRh presumably because they are profoundly unwell. Children with joint pain/stiffness but normal ESR had longer delays suggesting that if blood tests do not indicate inflammation, the diagnosis of JIA may be overlooked.

KEY WORDS: Inflammatory arthritis, Juvenile idiopathic arthritis, Presenting symptoms, Symptom duration, Outcome, Paediatric rheumatology

*N Adib and K Hyrich equally contributed to this work.

Submitted 13 September 2007; revised version accepted 4 February 2008.
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