Background/Purpose: Juvenile Idiopathic Arthritis (JIA) isthe most common chronic rheumatologic disease in children, which can significantly compromise quality of life. The objective of the study was to assess treatment responses and remission in the different categories of JIA.

Methods: Children with JIA were treated from their first presentation in a tertiary centre according to ACR recommendations for JIA, for a duration of 18 months. Responses to treatment at the end of 18 months were monitored by change in Juvenile Arthritis Disease Activity Score (JADAS) 27 and PedACR30, 70 and 90. Remission was assessed by JADAS27, JADAS10 and cJADAS10 inactive disease state and Wallace remission criteria. Disability was quantified by CHAQ-Disability index at end of follow-up.

Results: Two hundred and twenty children with JIA were included in the study: 80 (36.3%) had Polyarticular JIA, 71 (32.2%) Enthesitis-related, 34 (15.4%) each had Systemic and Oligoarticular and 1 (0.5%) Psoriatic JIA. After 18 months, there was significant drop in mean JADAS27 (from 26.8 to 10). Inactive disease state according to JADAS27 was achieved in 13.9% children overall (13.75% Polyarticular, 15.49% Enthesitis-related, 8.82% Systemic and 17.65% of Oligoarticular JIA; no statistically significant difference between any group). JADAS27 low disease activity was achieved in 29.5% children. JADAS10 and cJADAS10 inactive disease state were achieved by 14.6% and 15.4% children respectively (Table 1). There was strong correlation between JADAS10 and cJADAS10 (Spearman’s correlation coefficient at baseline and 18 months, 9.5 and 9.76, respectively). Wallace remission criteria was satisfied by 23.9% children. PedACR 30, 70 and 90 responses were achieved in 81.8%, 50.7% and 26.7% respectively. Mean CHAQ-DI at 18 months was 0.5 (0.31 Polyarticular, 0.23 Enthesitis-related, 1.37 Systemic and 0.08 in Oligoarticular JIA; significantly more in Systemic and Polyarticular JIA versus Oligoarticular). Eighteen percent children required no DMARDs (only NSAIDs and intra-articular corticosteroids), 73% one DMARD and 9% two DMARDs. Systemic steroids was required in 32.4% children overall, being significantly more in Systemic JIA (88.2%). Biologic therapy was given to 28/220 (12.7%) children, being significantly more in Systemic JIA, 15/34 (44.1%) in comparison to 7/71 (9.8%) of Enthesitis related JIA, 5/80 (6.2%) of RF +ve Polyarticular JIA and 1/34 (3%) of Oligoarticular JIA. Tocilizumab was used in Systemic JIA, Rituximab in Polyarticular JIA and anti-TNF in Oligoarticular and Enthesitis-related arthritis. At 6 months after biologics, 19/28 (67.9%) of the children achieved JADAS27 inactive state and 3/28 (10.7%) achieved JADAS27 low disease activity.

Conclusion: Remission according to JADAS27 occurred in only a minority of children with JIA, despite optimum treatment. cJADAS10 may be an effective substitute to JADAS10.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-treatment-responses-with-special-reference-to-remission-using-juvenile-arthritis-disease-activity-score-jadas-in-the-different-categories-of-juvenile-idiopathic-arthritis/