- Oral presentation
- Open Access
The risk and nature of flares in juvenile idiopathic arthritis: results from the reACCh-Out cohort
© Guzman et al; licensee BioMed Central Ltd. 2014
- Published: 17 September 2014
- Juvenile Idiopathic Arthritis
- Active Joint
- Cumulative Probability
- Disease Manifestation
Accurate description of the risk and nature of flares will help counsel families when JIA is controlled and when considering discontinuing treatment.
To describe the probability and characteristics of flares across JIA categories in an inception cohort of Canadian children treated with a contemporary approach.
We studied children diagnosed with JIA between 2005 and 2010 who had at least one visit with inactive disease while being prospectively followed in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. They received usual pediatric rheumatology care at 16 Canadian centres. Flare was defined as any recurrence of disease manifestations after attaining inactive disease (no active joints, no extraarticular manifestations and a physician global assessment <10mm). Flares were considered major if they required re-initiation or intensification (a new drug was started) of anti-rheumatic treatment. Risk of flare was calculated with Kaplan-Meier survival methods starting at the time of attainment of inactive disease, and at the time of discontinuing all treatment.
Cumulative probability of flare within 6 and 12 months of stopping treatment
Subjects stopping treatment / total
Risk within 6 months (%)
Risk within 12 months (%)
37 / 66
44 / 75
318 / 481
77 / 152
85 / 209
4 / 34
Flares after attaining inactive disease were common in this JIA cohort, and the risk was lowest for systemic JIA and highest for RF-positive polyarthritis. Flares after stopping treatment were uncommon in systemic JIA, but occurred in up to 45% of children within one year in other JIA categories. About half the flares required intensification or re-initiation of treatment.
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