Mortality in juvenile idiopathic arthritis - increased in systemic juvenile idiopathic arthritis.

What is it about?

Mortality rates in children with juvenile idiopathic arthritis (JIA) have been reported to be increased compared to the general population, however this is not a consistent finding. The type of JIA that a child has and how severe this is are thought to influence mortality. The aim of this study was to investigate mortality rates in patients with severe JIA compared to the general population. Children were enrolled in either the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study (BSPAR-ETN) or the Biologics for Children with Rheumatic Disease (BCRD) study. Of 1556 children, 10 of these children had died, 5 in the most severe category of JIA and 5 amongst the other subtypes. The causes of death were varied and included infection, complications after transplant surgery and asthma. Arthritis was mentioned on the death certificate of 7 of the children. Overall patients with JIA had higher mortality rates compared to the general population at 1.1 deaths per 1,000 patient years. This was increased further in patients with more severe disease.

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Why is it important?

Although death was a very rare outcome, mortality rates in this cohort of children with severe JIA were high overall. This highlights the severity of JIA as a disease in children and promotes early recognition of disease and referral to specialist care of all children suspected of having JIA. Future studies of children with JIA will allow an understanding of whether newer therapies can reduce this high mortality rates, particularly among children with more severe disease.

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