Abstract | BACKGROUND: To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target. METHODS: Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration. RESULTS: In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from - 0,82; 0.68), nor for BA (varying from - 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (- 1.48; - 0.68) compared to arm 1 (- 0.84; - 0.04) and arm 2 (- 0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1). CONCLUSIONS: Recent-onset JIA patients, treated-to-target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment. TRIAL REGISTRATION: NTR, NL1504 (NTR1574). Registered 01-06-2009.
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Authors | P C E Hissink Muller, W G van Braak, D Schreurs, C M Nusman, S A Bergstra, R Hemke, D Schonenberg-Meinema, J M van den Berg, T W Kuijpers, Y Koopman-Keemink, M A J van Rossum, L W A van Suijlekom-Smit, D M C Brinkman, C F Allaart, R Ten Cate, M Maas |
Journal | Pediatric rheumatology online journal
(Pediatr Rheumatol Online J)
Vol. 17
Issue 1
Pg. 62
(Sep 04 2019)
ISSN: 1546-0096 [Electronic] England |
PMID | 31484539
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
- Antirheumatic Agents
- Etanercept
- Methotrexate
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Topics |
- Antirheumatic Agents
(therapeutic use)
- Arthritis, Juvenile
(diagnostic imaging, pathology)
- Bone Density
- Child
- Child, Preschool
- Disease Progression
- Etanercept
(therapeutic use)
- Female
- Humans
- Male
- Methotrexate
(therapeutic use)
- Patient Care Planning
- Radiography
- Wrist
(diagnostic imaging, pathology)
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