Clinical remission and subsequent relapse in patients with juvenile idiopathic arthritis : predictive factors according to therapeutic approach
| Autor: | Salvador Quintana, Mireia Castillo-Vilella, Jose Luis Tandaipan, Consuelo Modesto, Nuria Giménez |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Arthritis Diseases of the musculoskeletal system Pediatrics Clinical Protocols Quality of life Recurrence immune system diseases Immunology and Allergy Relapse skin and connective tissue diseases HLA-B27 Antigen Remission Induction Antirheumatic Agents Child Preschool Withdrawal Cohort Female Drug Monitoring Immunosuppressive Agents Research Article musculoskeletal diseases medicine.medical_specialty Adolescent Subsequent Relapse Medication Therapy Management Remission Juvenile arthritis RJ1-570 Therapeutic approach Sex Factors Rheumatology Monitoring Immunologic Internal medicine medicine Humans Biological Products HLA-B27 business.industry medicine.disease Arthritis Juvenile DMARD Methotrexate RC925-935 Pediatrics Perinatology and Child Health Quality of Life Observational study business Predictor |
| Zdroj: | Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona Pediatric Rheumatology Online Journal Pediatric Rheumatology Online Journal, Vol 19, Iss 1, Pp 1-10 (2021) |
| Popis: | Background Juvenile idiopathic arthritis constitutes a significant cause of disability and quality of life impairment in pediatric and adult patients. The aim of this study was to ascertain clinical remission (CR) and subsequent relapse in juvenile idiopathic arthritis (JIA) patients, according to therapeutic approach and JIA subtype. Evidence in literature regarding its predictors is scarce. Methods We conducted an observational, ambispective study. Patients diagnosed of JIA, treated with synthetic and/or biologic disease modifying antirheumatic drugs (DMARD) were included and followed-up to December 31st, 2015. Primary outcome was clinical remission defined by Wallace criteria, both on and off medication. In order to ascertain CR according to therapeutic approach, DMARD treatments were divided in four groups: 1) synthetic DMARD (sDMARD) alone, 2) sDMARD combined with another sDMARD, 3) sDMARD combined with biologic DMARD (bDMARD), and 4) bDMARD alone. Results A total of 206 patients who received DMARD treatment were included. At the time the follow-up was completed, 70% of the patients in the cohort had attained CR at least once (144 out of 206), and 29% were in clinical remission off medication (59 out of 206). According to treatment group, CR was more frequently observed in patients treated with synthetic DMARD alone (53%). Within this group, CR was associated with female sex, oligoarticular persistent subtypes, ANA positivity, Methotrexate treatment and absence of HLA B27, comorbidities and DMARD toxicity. 124 DMARD treatments (62%) were withdrawn, 64% of which relapsed. Lower relapse rates were observed in those patients with persistent oligoarticular JIA (93%) when DMARD dose was tapered before withdrawal (77%). Conclusions More than two thirds of JIA patients attained CR along the 9 years of follow-up, and nearly one third achieved CR off medication. Females with early JIA onset, lower active joint count and ANA positivity were the ones achieving and sustaining remission more frequently, especially when receiving synthetic DMARD alone and in the absence of HLA B27, comorbidities or previous DMARD toxicity. |
| Databáze: | OpenAIRE |
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