Persistent elevation of fibrin D-dimer predicts longterm outcome in systemic juvenile idiopathic arthritis
UMass Chan Affiliations
Department of PediatricsDocument Type
Journal ArticlePublication Date
2009-02-01Keywords
AdolescentAdult
Arthritis, Juvenile Rheumatoid
Arthrography
Biological Markers
Child
Cohort Studies
Female
Fibrin Fibrinogen Degradation Products
Humans
Joints
Male
Outcome Assessment (Health Care)
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Treatment Outcome
Up-Regulation
Young Adult
Pediatrics
Rheumatology
Metadata
Show full item recordAbstract
OBJECTIVE: We previously demonstrated that levels of fibrin d-dimer correlate with disease activity and response to therapies in systemic juvenile idiopathic arthritis (sJIA). We hypothesized that persistence of D-dimer elevation in the patterns previously described, but over a longer followup period, would signal poor outcome. METHODS: We studied 31 children identified from 2 centers. Subjects were assigned a risk category based on their first obtained D-dimer concentration. Risk categories were based on results of our initial study, where normalization of D-dimer in patients no longer taking immunosuppressive therapy predicted good short-term outcome, and persistent D-dimer elevation while taking immunosuppressives predicted bad outcome (radiographic abnormalities, joint replacement surgery, or poor functional class) or a severe systemic manifestation. Outcome was determined at the last followup visit, a minimum of 2 years after measurement of the initial d-dimer level. RESULTS: The 31 children were a mean 16.4 years old at an average of 8.8 years after their initial diagnosis. Ten children had a severe outcome during this period; all 10 had a study baseline risk category of "high." Of the 14 subjects who had a high risk category at study baseline, none had a mild outcome. CONCLUSION: Our study indicated that a paradigm of risk of severe disease based upon persistent elevation of fibrin d-dimer on first measurements (greater than a mean of 29 months in our initial study and at least 24 months in the additional subjects) is promising to predict poor longer-term outcome in sJIA. A larger prospective study is warranted to substantiate the preliminary data and assess the relative comparative value to other biomarkers and clinical endpoints.Source
J Rheumatol. 2009 Feb;36(2):422-6. Link to article on publisher's siteDOI
10.3899/jrheum.070600Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43872PubMed ID
19040298Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.3899/jrheum.070600