Decreased frequency of allergy in juvenile idiopathic arthritis: Results of a case-control study

Abstract

Objectives

To determine the frequency of Th2-mediated allergic diseases (AD) in mainly Th1-driven juvenile idiopathic arthritis (JIA) subtypes.

Methods

Ninety-nine JIA patients and 128 control subjects were enrolled in a prospective case-control study. All subjects were assessed with standard allergy questionnaire, complete blood cell count, and total serum immunoglobulin (sIg) E. sIgs G, A, M, Juvenile Arthritis Disease Activity Score-27 (JADAS27), and serum acute phase reactants (sAPR) were obtained in JIA. In the presence of allergic symptoms, skin prick (SPT) and pulmonary function tests (PFT) were performed.

Results

Despite similar allergy risk factors, the frequencies of asthma and allergic rhinitis were lower in JIA group (all p ≤ .02). Allergic patients with JIA performed lower FEV₁/FVC ratio, PEF, and FEF25–75 compared to the control group (all p ≤ .04). JADAS27 and sAPR were similar among JIA patients with and without AD. Two JIA patients were found to have hypogammaglobulinemia.

Conclusion

The frequencies of AD, asthma, and allergic rhinitis may decrease in Th1-mediated JIA subtypes although the coexistence does not appear to affect the severity of arthritis whereas allergic symptoms may resolve after immunosuppressive treatment. PFTs should be obtained periodically in JIA. JIA patients may have an underlying primary immunodeficiency (ID) or immunosuppressive drugs may cause secondary ID.

KEY POINTS

• Compared to the population, the frequency of Th2-mediated allergic diseases is lower in oligoarthritis and RF-negative polyarthritis that are primarily driven by a Th1 activity.

• The coexistence of allergic diseases in juvenile idiopathic arthritis does not affect the severity of arthritis.

• Pulmonary function tests can be thought to be obtained periodically in juvenile idiopathic arthritis.

• Immunological workup should be considered in atypically or severely presented patients with juvenile idiopathic arthritis before the initiation of immunosuppressive therapy to differentiate primary and secondary immunodeficiency.

Keywords:

• Allergic disease
• allergic rhinitis
• asthma
• immunodeficiency disorders
• juvenile idiopathic arthritis

Acknowledgments

The authors would like to thank Burak Uzmez and Nurgul Yuce for their assistance in coordinating the project. We also thank our specialized pulmonary nurses, Gulizar Demirli and Gunseli Ay.

Conflict of interest

None.