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Treatment prescribing patterns in a cohort of patients with juvenile idiopathic arthritis (JIA). Data from the childhood arthritis prospective study (CAPS)
© Davies et al; licensee BioMed Central Ltd. 2014
- Published: 17 September 2014
- Juvenile Idiopathic Arthritis
Juvenile idiopathic arthritis (JIA) is a heterogenous disease, classified according to the International League of Associations for Rheumatology (ILAR). Initial treatment is based largely on disease severity; intra-articular injections for oligoarthritis, methotrexate (MTX) for polyarthritis and systemic presentations. The recent licensing of biologic therapies for use in JIA has revolutionised treatment of the disease. It is not currently known what proportion of children who present with polyarthritis will require biologic therapy. Although not studied formally, it is recognised a proportion of children with oligoarthritis will also require systemic therapy to control symptoms.
To describe prescribing patterns in JIA over the first 3 years on presentation to rheumatology.
Children with at least 3 years of follow-up within the Childhood Arthritis Prospective Study (CAPS), a prospective observational inception study of inflammatory arthritis, were included.
For analysis, children were placed into one of 4 groups based on physician-assigned ILAR category and number of active joints at first presentation (baseline): oligoarthritis, polyarthritis, systemic (sJIA) and enthesitis-related arthritis (ERA). All treatment exposures were categorised into NSAID, intra-articular steroids, disease modifying anti-rheumatic drug (DMARD) including MTX and sulphasalazine (SSZ) and biologics including adalimumab (ADA), etanercept (ETN), infliximab (INF), and tocilizumab (TCZ).
Arthritis pattern at presentation
Ever had a DMARD, n(%)
Ever had a biologic, n(%)
Over a three year period almost all patients with polyarthritis received treatment with MTX and almost 50% also received a biologic therapy. A high proportion of children presenting with oligoarthritis also went on to receive DMARDs and biologics, many children for persistent oligoarthritis. This is despite the lack of clinical trial evidence for effectiveness in this subtype. Further studies on the efficacy/effectiveness in this subtype should be undertaken to ensure appropriate use of advanced therapies in this population.
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