Time of Disease-Modifying Antirheumatic Drug Start in Juvenile Idiopathic Arthritis and the Likelihood of a Drug-Free Remission in Young Adulthood.

Abstract

OBJECTIVE:

To study juvenile idiopathic arthritis (JIA) long-term outcomes in relation to the time of initiation of biologic disease-modifying antirheumatic drug (bDMARD).

METHODS:

Outcomes of JIA patients prospectively followed by the Biologika in der Kinderrheumatologie (BiKeR) and Juvenile Arthritis Methotrexate/Biologics Long-Term Observation (JuMBO) registers were analyzed with regard to drug-free remission and inactive disease, functional status and quality of life, and surgery. To analyze the influence of early bDMARD therapy on outcomes, patients were assigned to 3 groups based on the time from symptom onset to bDMARD start (G1: ≤2 years, G2: >2 to ≤5 years, and G3: >5 years). Propensity score-adjusted outcome differences were analyzed by multinomial logistic regression analyses among the groups.

RESULTS:

A total of 701 JIA patients were observed for mean ± SD 9.1 ± 3.7 years. At the last follow-up (disease duration mean ± SD 14.3 ± 6.1 years), 11.7% of patients were in drug-free remission, and 40.0% had inactive disease. More than half of the patients reported no functional limitation, while 5% had undergone arthroplasty, and 3% had eye surgery. At the 10-year time point, patients in G1 (n = 108) were significantly more likely to be in drug-free remission than those patients who began treatment later (G2, n = 199; G3, n = 259), with 18.5%, 10.1%, and 4.9%, respectively. Patients in G1 had significantly lower disease activity (clinical Juvenile Arthritis Disease Activity Score in 10 joints = 4.9), a better overall well-being (18.2% patient global assessment score = 0), and higher functional status (59.2% Health Assessment Questionnaire score = 0), compared to patients in G3 (7.1, 8.4%, and 43.7%, respectively). G1 patients required arthroplasty significantly less frequently than G3 patients and had significantly lower disease activity over time than patients in both G2 and G3.

CONCLUSION:

Early DMARD treatment is associated with better disease control and outcomes, which supports the concept of a "window of opportunity" for JIA.

• Authors: Kirsten Minden, Gerd Horneff, Martina Niewerth, Eva Seipelt, Martin Aringer, Peer Aries, Ivan Foeldvari, Johannes-Peter Haas, Ariane Klein, Stefanie Tatsis, Klaus Tenbrock, Angela Zink, Jens Klotsche
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 71 Issue 4 Pg. 471-481 (04 2019) ISSN: 2151-4658 [Electronic] United States
• PMID: 30044538 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2018, American College of Rheumatology.

Chemical References

• Antirheumatic Agents

Topics

• Adolescent
• Antirheumatic Agents (administration & dosage)
• Arthritis, Juvenile (drug therapy, surgery)
• Child
• Female
• Follow-Up Studies
• Humans
• Male
• Prospective Studies
• Remission, Spontaneous
• Treatment Outcome