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28-02-2019 | Rheumatology | News | Article

Substantial proportion of patients with JIA have ongoing disease as adults

medwireNews: Almost half of patients with juvenile idiopathic arthritis (JIA) have ongoing active disease during early adulthood, with the burden particularly high among those with enthesitis-related arthritis (ERA), researchers report.

The study, by Mia Glerup (Aarhus University Hospital, Denmark) and colleagues, included 434 patients (mean age 24 years) from Denmark, Norway, Sweden, and Finland who were diagnosed with JIA between 1997 and 2000. Of these, 329 attended a clinical follow-up visit 18 years after disease onset while the remainder completed a telephone interview and online questionnaires.

Among the patients who attended the clinical follow-up visit, 45.6% had active disease according to ACR preliminary criteria, 10.0% were in clinical remission on medication, 32.8% were in clinical remission off medication, and 11.6% had inactive disease that did not fulfill the remission criteria.

The proportion with active disease varied across JIA categories, and was highest among the patients with ERA, at 64.9%. This was despite ERA patients having the highest rate of biologic medication use (37.8%), the researchers note.

By contrast, patients with persistent oligoarticular and systemic JIA had the highest rates of clinical remission, at 54.2% and 53.8%, respectively.

At the follow-up visit, the median juvenile arthritis disease activity score assessed in 71 joints (JADAS71) was 1.5 points overall, but the researchers note that scores differed significantly among JIA categories; patients with ERA (n=37) had the highest score, at 4.5 points, while those with systemic (n=13) or oligopersistent (n=72) JIA had a score of 0.

Just under half (48.3%) of participants had inactive disease as defined by a JADAS71 score of less than 1 point.

During the course of their disease, 59.7% of patients had received DMARDs and 29.5% had been treated with biologics. At the time of the follow-up visit, the proportions on each of these treatments were 20.0% and 19.2%, respectively.

Of note, the rate of biologic use among patients with ERA (37.8%) was significantly higher than the rate among patients with any other type of JIA, and the researchers also found that more than one-third (37.4%) of all patients with active disease were not taking any medication at all.

“Our results confirm the conceptual knowledge of JIA as a chronic disease since only 33% of the JIA participants were in complete remission for at least 12 months off medication 18 years after disease onset,” Glerup and co-authors conclude in Arthritis Care & Research.

However, they also point out that “the vast majority of patients with active disease were in the very mild range of the activity scale and many of the patients even had such a mild disease activity that medication was considered unnecessary.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group