Early aggressive treatment of JIA in Australia means that children achieve high rates of joint remission, but many go on to have flares.
A review of outcomes for 134 children treated for JIA at the nation’s largest paediatric rheumatology centre – at the Royal Children’s Hospitals in Melbourne – also found that most require ongoing medication.
The retrospective evaluation of outcomes for children treated in between 2010 and 2014 found that 95% achieved a joint count of zero within the first year of treatment (median of 4.1 months), but flares occurred in 42%.
At 12 months 65% of children had no active joint disease, though 73% were on medications.
Overall, the most common treatments were NSAIDs (94%), methotrexate (62%), oral steroids (53%) and a biologic DMARD (15%). Intra-articular steroids were used in 62%, most commonly in the oligoarticular subtype (94%).
The median number of flares was one and the median time to flare was 3.6 months. About half the children were on a DMARD at the time of the flare, which were most likely to be seen in children with undifferentiated JIA (65% of patients flaring over the first 12 months).
At 12 months, two thirds of patients had inactive arthritis, of whom 61% were on medications and 39% were off medication. The categories most likely to have inactive joint disease and be off medication at 12 months were patients with oligoarthritis (50%) and systemic JIA (30%).
Of the one third patients with active arthritis at 12 months, almost all were on medication. Children with polyarticular RF negative (47%) and enthesitis-related arthritis (46%) had the highest likelihood of active arthritis at 12 months.
The study investigators, led by paediatric rheumatologist Dr Georgina Tiller said the findings showed that outcomes in Australian children with JIA were generally similar to overseas cohorts of children with JIA.
“These data suggest modern therapies in JIA are effective in controlling active joint disease in the majority of patients but that the underlying tendency to relapse – and therefore need for ongoing treatment – remains high,” they commented in Paediatric Rheumatology.
However they noted that use of oral corticosteroids appeared to be higher in Australia than in other countries, though it appeared to be mostly short term use as a ‘bridging’ measure to manage symptoms while awaiting onset of action of DMARDS, or for joint injections.
“Ongoing research is required to further understand determinants of disease course and optimum management strategies,” they concluded.