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Time of Disease‐Modifying Antirheumatic Drug Start in Juvenile Idiopathic Arthritis and the Likelihood of a Drug‐Free Remission in Young Adulthood
Author(s) -
Minden Kirsten,
Horneff Gerd,
Niewerth Martina,
Seipelt Eva,
Aringer Martin,
Aries Peer,
Foeldvari Ivan,
Haas JohannesPeter,
Klein Ariane,
Tatsis Stefanie,
Tenbrock Klaus,
Zink Angela,
Klotsche Jens
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23709
Subject(s) - medicine , arthritis , methotrexate , juvenile , disease , antirheumatic drugs , quality of life (healthcare) , drug , juvenile rheumatoid arthritis , physical therapy , surgery , antirheumatic agents , pharmacology , genetics , nursing , biology
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 (Ju MBO ) 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 .