MD462Z - Method for predicting the evolution of juvenile idiopathic arthritis - Google Patents
Method for predicting the evolution of juvenile idiopathic arthritis Download PDFInfo
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- 238000000034 method Methods 0.000 title claims abstract description 15
- 208000003456 Juvenile Arthritis Diseases 0.000 title claims description 21
- 206010059176 Juvenile idiopathic arthritis Diseases 0.000 title claims description 21
- 201000002215 juvenile rheumatoid arthritis Diseases 0.000 title claims description 21
- 201000010099 disease Diseases 0.000 claims abstract description 32
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 claims abstract description 32
- 208000006820 Arthralgia Diseases 0.000 claims abstract description 9
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- 206010003246 arthritis Diseases 0.000 abstract description 3
- 239000003814 drug Substances 0.000 abstract description 3
- 230000000366 juvenile effect Effects 0.000 abstract 2
- 238000003745 diagnosis Methods 0.000 description 5
- 230000000694 effects Effects 0.000 description 4
- 238000004393 prognosis Methods 0.000 description 4
- 230000009885 systemic effect Effects 0.000 description 4
- 238000001514 detection method Methods 0.000 description 3
- 230000002349 favourable effect Effects 0.000 description 3
- 230000001225 therapeutic effect Effects 0.000 description 3
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- 102000011767 Acute-Phase Proteins Human genes 0.000 description 1
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Abstract
Изобретение относится к медицине, в частности к детской ревматологии.Метод, согласно изобретению, включает клиническое и параклиническое обследования, которые выявляют следующие параметры: возраст пациента (VD) в начале заболевания, длительность заболевания (DM), число болезненных суставов (NAD) в начале заболевания, рентгенологическую стадию по Штеинброкеру (SR), затем вычисляют дискриминантную функцию по формуле:F= -1,5506+0,1559·NAD+1,0802·SR-0,0208·VD+0,0163·DM,и в случае, когда F>0, прогнозируют негативную эволюцию ювенильного идеопатического артрита, а когда F<0 - позитивную эволюцию ювенильного идеопатического артрита.The invention relates to medicine, in particular to pediatric rheumatology. The method according to the invention includes clinical and paraclinical examinations, which reveal the following parameters: patient age (VD) at the beginning of the disease, duration of the disease (DM), number of painful joints (NAD) at the beginning diseases, the radiological stage according to Steinbroker (SR), then the discriminant function is calculated according to the formula: F = -1.5506 + 0.1559 · NAD + 1.0802 · SR-0.0208 · VD + 0.0163 · DM, and when F> 0, the negative evolution of juvenile ideopathic arthritis is predicted, and when F <0 - positive evolution of juvenile ideopathic arthritis.
Description
Invenţia se referă la medicină, în special la reumatologia pediatrică. The invention relates to medicine, in particular to pediatric rheumatology.
Artrita juvenilă idiopatică (AJI) este o maladie înalt invalidizantă care conduce la compromitere funcţională şi handicap fizic prin leziunile osteoarticulare şi determină mortalitate prematură prin afecţiunile sistemice, având un impact medical, social şi economic major [1]. Juvenile idiopathic arthritis (JIA) is a highly disabling disease that leads to functional impairment and physical disability through osteoarticular lesions and causes premature mortality through systemic diseases, having a major medical, social and economic impact [1].
Prin numeroase studii s-a încercat determinarea factorilor de pronostic ai evoluţiei artritei juvenile idiopatice. Astfel, într-un studiu s-a determinat că indici de pronostic nefavorabil ai evoluţiei artritei juvenile idiopatice sunt forma poliarticulară şi oligoarticulară extensivă, clasa funcţională după Steinbrocker III-IV, indicii reactanţi de fază acută majoraţi, scala vizuală analoagă a durerii, precum şi durata mare a bolii [2]. Numerous studies have attempted to determine the prognostic factors for the progression of juvenile idiopathic arthritis. Thus, in one study, it was determined that unfavorable prognostic indicators for the progression of juvenile idiopathic arthritis are the extensive polyarticular and oligoarticular form, Steinbrocker functional class III-IV, increased acute phase reactant indices, visual analogue pain scale, and long duration of the disease [2].
Dezavantajul acestei metode constă în faptul că nu este luată în calcul vârsta pacientului la debutul maladiei, care reprezintă un indice foarte important de pronostic al evoluţiei în orice maladie şi nu necesită instrumentar suplimentar. De asemenea, nu a fost analizat stadiul radiologic după Steinbrocker care este simplu de efectuat, dar care furnizează date utile despre progresia maladiei (tumefacţia părţilor moi, lărgirea sau diminuarea spaţiului articular, semne de osteoporoză, tulburări de creştere segmentară, eroziuni ale osului subcondral, distrucţii cartilaginoase şi osoase, anchiloză osoasă sau fibroasă, deformări articulare, poziţii vicioase, subluxaţii). Este necesar ca prin folosirea unui minim de indici clinici şi paraclinici de a pronostica obiectiv evoluţia artritei idiopatice. The disadvantage of this method is that the patient's age at the onset of the disease is not taken into account, which is a very important prognostic index of the evolution in any disease and does not require additional instrumentation. Also, the radiological stage according to Steinbrocker was not analyzed, which is simple to perform, but which provides useful data on the progression of the disease (swelling of the soft parts, widening or narrowing of the joint space, signs of osteoporosis, segmental growth disorders, erosions of the subchondral bone, cartilaginous and bone destruction, bone or fibrous ankylosis, joint deformities, vicious positions, subluxations). It is necessary to use a minimum of clinical and paraclinical indices to objectively predict the evolution of idiopathic arthritis.
Matematic problema, fiind formulată, se reduce la deducerea funcţiei discriminante în baza analizei datelor a două selecţii (pacienţi cu răspuns favorabil la tratament şi pacienţi cu răspuns nefavorabil la tratament), care să permită a atribui un nou element (pacient nou internat) la una din cele două mulţimi cu o exactitate destul de bună. Folosirea analizei discriminante în analiza datelor statistice despre pacienţii trataţi ne-a permis să deducem funcţia discriminantă propusă mai jos şi care este pusă în esenţa metodei de pronosticare. Mathematically, the problem, being formulated, is reduced to deducing the discriminant function based on the data analysis of two selections (patients with a favorable response to treatment and patients with an unfavorable response to treatment), which allows to attribute a new element (newly hospitalized patient) to one of the two sets with quite good accuracy. The use of discriminant analysis in the analysis of statistical data about treated patients allowed us to deduce the discriminant function proposed below and which is at the heart of the prognostic method.
Problema pe care o rezolvă invenţia este crearea unei metode mai simple şi obiective de pronosticare a evoluţiei artritei juvenile idiopatice. The problem solved by the invention is the creation of a simpler and more objective method for predicting the evolution of juvenile idiopathic arthritis.
Esenţa invenţiei constă în aceea că metoda de pronosticare a evoluţiei artritei juvenile idiopatice include examenul clinic şi paraclinic, ce relevă următorii parametri: vârsta pacientului la debutul maladiei (VD), durata maladiei (DM), numărul de articulaţii dureroase la debutul maladiei (NAD), stadiul radiologic după Steinbrocker (SR), după care se calculează funcţia discriminantă conform formulei: The essence of the invention is that the method for predicting the evolution of juvenile idiopathic arthritis includes clinical and paraclinical examination, which reveals the following parameters: patient's age at the onset of the disease (VD), disease duration (DM), number of painful joints at the onset of the disease (NAD), radiological stage according to Steinbrocker (SR), after which the discriminant function is calculated according to the formula:
F= -1,5506+0,1559·NAD+1,0802·SR-0,0208·VD+0,0163·DM, F= -1.5506+0.1559·NAD+1.0802·SR-0.0208·VD+0.0163·DM,
unde parametrilor menţionaţi li se atribuie următoarele valori: where the mentioned parameters are assigned the following values:
VD vârsta pacientului la debutul maladiei, luni VD patient's age at the onset of the disease, months
DM durata maladiei, luni DM disease duration, months
NAD numărul de articulaţii dureroase la debutul maladiei NAD number of painful joints at the onset of the disease
SR stadiul radiologic după Steinbrocker, având următoarele valori: SR radiological stage according to Steinbrocker, having the following values:
ST 1 - 1 ST 1 - 1
ST II - 2 ST II - 2
ST III - 3 ST III - 3
ST IV - 4 ST IV - 4
şi în cazul în care F>0 se pronostichează o evoluţie negativă, iar când F<0 - o evoluţie pozitivă a artritei juvenile idiopatice. and if F>0 a negative evolution is predicted, and when F<0 - a positive evolution of juvenile idiopathic arthritis.
Rezultatul constă în creşterea exactităţii pronosticării evoluţiei nefavorabile a artritei juvenile idiopatice, datorită utilizării în metoda dată a parametrilor clinici: vârsta pacientului la debutul maladiei, durata maladiei, numărul de articulaţii dureroase şi paraclinici: stadiul radiologic după Steinbrocker. The result is an increase in the accuracy of predicting the unfavorable evolution of juvenile idiopathic arthritis, due to the use in this method of clinical parameters: the patient's age at the onset of the disease, the duration of the disease, the number of painful joints and paraclinical parameters: the radiological stage according to Steinbrocker.
Avantajul constă în sporirea exactităţii şi obiectivizării pronosticării evoluţiei nefavorabile a artritei juvenile idiopatice. Metoda propusă permite depistarea precoce a bolnavilor cu risc sporit de agravare, fapt ce impune o atenţie sporită pentru această categorie de pacienţi cu corijare la timp a programului terapeutic. The advantage lies in increasing the accuracy and objectivity of the prognosis of the unfavorable evolution of juvenile idiopathic arthritis. The proposed method allows for the early detection of patients with an increased risk of worsening, which requires increased attention for this category of patients with timely correction of the therapeutic program.
La etapa iniţială s-a efectuat examenul clinic primar (cu atenţie deosebită asupra sistemului osteoarticular), anamneza heredo-colaterală, radiografia articulară (aprecierea stadiului radiologic după metoda Steinbrocker O., Traeger C.H., Battma R.G. Therapeutic criteria in rheumatoid artritis. J Am Med Assoc 1949; nr.140, c. 659-662). At the initial stage, the primary clinical examination was performed (with special attention to the osteoarticular system), the family history, and the joint radiography (assessment of the radiological stage according to the method of Steinbrocker O., Traeger C.H., Battma R.G. Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc 1949; no. 140, c. 659-662).
Verificarea funcţiei discriminante s-a efectuat pe un lot de 51 pacienţi cu diagnosticul - artrită juvenilă idiopatică, apreciindu-se evoluţia clinică, gradul de activitate, clasa funcţională şi stadiul radiologic după Steinbrocker pe parcursul unui an. În cazul în care F>0 se pronostichează o evoluţie negativă, iar când F<0 - o evoluţie pozitivă a artritei juvenile idiopatice. The discriminant function was tested on a group of 51 patients with the diagnosis of juvenile idiopathic arthritis, assessing the clinical evolution, degree of activity, functional class and radiological stage according to Steinbrocker over a year. If F>0, a negative evolution is predicted, and when F<0 - a positive evolution of juvenile idiopathic arthritis.
Drept indicaţie pentru utilizarea acestei metode constituie depistarea pacienţilor cu risc sporit de evoluţie negativă a artritei juvenile idiopatice în scopul întocmirii unei precoce tactici de tratament. An indication for using this method is the detection of patients at increased risk of negative evolution of juvenile idiopathic arthritis in order to develop an early treatment strategy.
Contraindicaţii pentru utilizarea acestei metode nu sunt. There are no contraindications for using this method.
Exemple concrete de realizare Concrete examples of implementation
Exemplul 1 Example 1
Pacientul S., 93 luni, a fost internat în secţia Reumatologie a ICŞDOSMC în stare gravă, stabilindu-se diagnosticul - artrită juvenilă idiopatică, formă sistemică, gradul III de activitate, clasa funcţională după Steinbrocker III, stadiul radiologic după Steinbrocker III. A fost aplicată metoda propusă de cercetare. S-au obţinut următoarele rezultate: VD - vârsta pacientului la debutul maladiei 41 luni, DM - durata maladiei 52 luni; NAD - numărul de articulaţii dureroase 14; SR - stadiul radiologic după Steinbrocker III. Patient S., 93 months old, was admitted to the Rheumatology Department of ICŞDOSMC in serious condition, the diagnosis being established - juvenile idiopathic arthritis, systemic form, activity level III, functional class according to Steinbrocker III, radiological stage according to Steinbrocker III. The proposed research method was applied. The following results were obtained: VD - patient's age at the onset of the disease 41 months, DM - disease duration 52 months; NAD - number of painful joints 14; SR - radiological stage according to Steinbrocker III.
Valoarea calculată a funcţiei discriminante F = 3,8674, adică F > 0, ceea ce permite de a pronostica o evoluţie nefavorabilă a maladiei. Metoda aplicată a demonstrat coincidenţa pronosticării cu rezultatul real la 1 an de supraveghere. The calculated value of the discriminant function F = 3.8674, i.e. F > 0, which allows to predict an unfavorable evolution of the disease. The applied method demonstrated the coincidence of the prediction with the real result at 1 year of surveillance.
Exemplul 2 Example 2
Pacientul I., 67 luni, la internare stare de gravitate medie, diagnosticul - artrită juvenilă idiopatică, formă sistemică, gradul I de activitate, clasa funcţională după Steinbrocker I, stadiul radiologic după Steinbrocker I. S-au înregistrat următoarele rezultate: VD - vârsta pacientului la debutul maladiei 36 luni, DM - durata maladiei 31 luni; NAD - numărul de articulaţii dureroase 4; SR - stadiul radiologic după Steinbrocker I. Patient I., 67 months old, on admission in a moderately severe condition, diagnosis - juvenile idiopathic arthritis, systemic form, activity level I, functional class according to Steinbrocker I, radiological stage according to Steinbrocker I. The following results were recorded: VD - patient's age at the onset of the disease 36 months, DM - duration of the disease 31 months; NAD - number of painful joints 4; SR - radiological stage according to Steinbrocker I.
Valoarea calculată a funcţiei discriminante F = -0,7351, adică F < 0, fapt care permite pronosticarea la acest pacient a unei evoluţii favorabile a maladiei, ceea ce demonstrează coincidenţa pronosticului cu rezultatul clinic favorabil. The calculated value of the discriminant function F = -0.7351, i.e. F < 0, which allows the prediction of a favorable evolution of the disease in this patient, which demonstrates the coincidence of the prognosis with the favorable clinical outcome.
Exemplul 3 Example 3
Pacienta A., 94 luni, a fost internată în secţia Reumatologie a ICŞDOSMC în stare de gravitate medie, fiind stabilit diagnosticul - artrită juvenilă idiopatică, formă sistemică, gardul II de activitate, clasa funcţională după Steinbrocker II, stadiul radiologic după Steinbrocker II. În urma investigaţiilor efectuate s-au obţinut următoarele rezultate: VD - vârsta pacientului la debutul maladiei 61 luni, DM - durata maladiei 33 luni; NAD - numărul de articulaţii dureroase 16; SR - stadiul radiologic după Steinbrocker II. Patient A., 94 months old, was admitted to the Rheumatology department of ICŞDOSMC in a moderately severe condition, the diagnosis being established - juvenile idiopathic arthritis, systemic form, activity level II, functional class according to Steinbrocker II, radiological stage according to Steinbrocker II. Following the investigations performed, the following results were obtained: VD - patient's age at the onset of the disease 61 months, DM - duration of the disease 33 months; NAD - number of painful joints 16; SR - radiological stage according to Steinbrocker II.
Valoarea calculată a funcţiei discriminante F = 1,6869, adică F > 0, ceea ce permite pronosticarea unei evoluţii negative a maladiei. În realitate însă, 12 luni de medicaţie au dus la o ameliorare evidentă a stării pacientei, fapt ce demonstrează necoincidenţa pronosticului cu rezultatul clinic pozitiv. The calculated value of the discriminant function F = 1.6869, i.e. F > 0, which allows the prognosis of a negative evolution of the disease. In reality, however, 12 months of medication led to an obvious improvement in the patient's condition, which demonstrates the non-coincidence of the prognosis with the positive clinical outcome.
Având la bază datele obţinute pe parcursul unui an de supraveghere a pacienţilor cu artrită juvenilă idiopatică, metoda propusă de pronosticare a evoluţiei artritei juvenile idiopatice permite depistarea precoce a bolnavilor cu risc sporit de agravare, fapt ce impune o atenţie deosebită pentru această categorie de pacienţi cu corijarea la timp a programului terapeutic. Based on data obtained during a year of surveillance of patients with juvenile idiopathic arthritis, the proposed method for predicting the evolution of juvenile idiopathic arthritis allows for the early detection of patients with an increased risk of worsening, which requires special attention for this category of patients with timely correction of the therapeutic program.
Studiul efectuat în baza datelor clinice, paraclinice a inclus 51 pacienţi cu diagnosticul: artrită juvenilă idiopatică, trataţi în secţia reumatologie a IMSP Institutul de Cercetări Ştiinţifice în Domeniul Ocrotirii Sănătăţii Mamei şi Copilului, catedra Pediatrie nr.1. The study conducted based on clinical and paraclinical data included 51 patients with the diagnosis: juvenile idiopathic arthritis, treated in the rheumatology department of the IMSP Institute for Scientific Research in the Field of Maternal and Child Health Protection, Pediatrics Department No. 1.
1. Minden K., Niewerth M., Listing J., Biedermann T., Bollow M., Schontube M., Zink A. Long-term outcome in patients with juvenile idiopathic artritis. Artritis and Rheum 2002, v.46, p.2392-2401 1. Minden K., Niewerth M., Listing J., Biedermann T., Bollow M., Schontube M., Zink A. Long-term outcome in patients with juvenile idiopathic arthritis. Arthritis and Rheum 2002, v.46, p.2392-2401
2. Zak M., Pedersen F.K. Juvenile chronic artritis into adulthood: a long-term follow-up stady. Rheumatology, 2000, v.39, p.198-204 2. Zak M., Pedersen F.K. Juvenile chronic arthritis into adulthood: a long-term follow-up study. Rheumatology, 2000, v.39, p.198-204
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| MDS20110123A MD462Z (en) | 2011-06-30 | 2011-06-30 | Method for predicting the evolution of juvenile idiopathic arthritis |
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| MDS20110123A MD462Z (en) | 2011-06-30 | 2011-06-30 | Method for predicting the evolution of juvenile idiopathic arthritis |
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Non-Patent Citations (4)
| Title |
|---|
| Minden K., Niewerth M., Listing J., Biedermann T., Bollow M., Schontube M., Zink A. Long-term outcome in patients with juvenile idiopathic artritis. Artritis and Rheum 2002, v.46, p.2392-2401 * |
| Steibrocker O., Traeger CH, Battma RG. Therapeutic criteria in rheumatoid artritis. J Am Med Assoc 1949; nr.140 659-662. * |
| Zak M., Pedersen F.K. Juvenile chronic artritis into adulthood: a long-term follow-up stady. Rheumatology, 2000, v.39, p.198-204 * |
| Новик Г.А., Абакумова Л.Н., Летенкова Н.В., Слизовский Н.В., Слизовская Н.Н. Ювенильные артриты - опыт диагностики и лечения www.lvrach.ru/2008/04/5001010 <http://www.lvrach.ru/2008/04/5001010/> * |
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