Premium
Outcome and Trends in Treatment of Systemic Juvenile Idiopathic Arthritis in the German National Pediatric Rheumatologic Database, 2000–2013
Author(s) -
Klotsche Jens,
Raab Anna,
Niewerth Martina,
Sengler Claudia,
Ganser Gerd,
Kallinich Tilmann,
Niehues Tim,
Hufnagel Markus,
Thon Angelika,
Hospach Toni,
Horneff Gerd,
Minden Kirsten
Publication year - 2016
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.39796
Subject(s) - medicine , arthritis , disease , juvenile , rheumatology , systemic disease , systemic therapy , pediatrics , physical therapy , database , genetics , cancer , breast cancer , biology , computer science
Objective To investigate the clinical presentation and medical treatment of patients with systemic juvenile idiopathic arthritis (JIA) during the first year of illness. Our study focused on 3‐year outcomes in a subsample of patients who were followed up longitudinally. Methods From 2000 to 2013, 597 patients with systemic JIA and a disease duration of ≤12 months were recorded in the National Pediatric Rheumatologic Database. Among those patients, 3‐year outcome data were available for 133. These data included the clinical Juvenile Arthritis Disease Activity Score in 10 joints (JADAS‐10) and the physician's global assessment score (on a numerical rating scale), as well as assessment of joint involvement, growth retardation, and patient‐reported outcomes. Results The median clinical JADAS‐10 declined significantly, from 7 in 2000 to 2 in 2013, while the proportion of patients with inactive disease increased from 19% in 2000 to 41% in 2013. The rate of treatment with systemic glucocorticoids and disease‐modifying antirheumatic drugs (DMARDs) remained stable from 2000 to 2013. By 2013, the proportion of patients with systemic JIA who were treated with biologic DMARDs had increased to 20%. At 3‐year follow‐up, 72% of patients with systemic JIA had inactive disease, and 77% had no functional limitations. Growth retardation was associated with persistently high disease activity and continuing treatment with systemic glucocorticoids. At the 3‐year follow‐up, one‐third of patients were still being treated with systemic glucocorticoids. Conclusion The proportion of patients with inactive disease has increased over the past decade. Possible explanations may include improved access to specialized care, additional treatment options, and earlier or faster step‐up treatment. However, challenges in the management of systemic JIA remain, as ∼30% of patients continue to present with ongoing active disease.