Long-term comorbidity patterns in juvenile idiopathic arthritis.
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OBJECTIVES: Juvenile idiopathic arthritis (JIA) leads to significant long-term morbidity from articular and extra-articular complications, yet the burden of comorbidities in adults with long-standing disease is not well characterised. This study aimed to determine the prevalence and incidence of key comorbidities in adults with JIA and assess their association with demographic and clinical features. METHODS: We performed a national multicentre retrospective cohort study using data from adults with JIA, defined by the 2001 ILAR criteria, enrolled in the Portuguese Rheumatic Diseases Register (Reuma.pt). Demographic and clinical data, along with comorbidities, were collected. Comorbidities included cardiovascular disease, hypertension, dyslipidaemia, diabetes, thyroid disease, amyloidosis, inflammatory bowel disease, allergy and asthma, osteoporosis, psychiatric disease, and autoimmune disease. Rare conditions were grouped into broader categories. Extra-articular JIA manifestations were excluded. Incidence rates were calculated as the number of new events per 1,000 person-years (95% CI), and prevalence was assessed using frequencies. RESULTS: The cohort included 748 patients, 65.6% female, with a median age of 27.7 years and a median disease duration of 20.6 years. Oligoarticular JIA was the most common subtype (29.9%). Autoimmune diseases had the highest incidence rate (7.1/1,000 person-years), followed by hypertension (5.1/1,000 person-years) and psychiatric disease (4.0/1,000 person-years). Hypertension (9%), psychiatric disease (8%), and osteoporosis (5%) were the most prevalent comorbidities. Biologic DMARD use was associated with reduced risk of psychiatric disease (OR=0.38, p=0.03), and no significant association with malignancy or infection was found. CONCLUSIONS: JIA patients with long-standing disease frequently develop comorbidities, particularly hypertension. Biologic therapy seems to reduce the risk of comorbidities. Long-term monitoring of comorbidities in JIA patients is paramount.