Background/Purpose:  The introduction of biologic agents at the beginning of the 2000s has represented a major advance in the management of juvenile idiopathic arthritis (JIA). These medications have been shown to be effective in a sizeable proportion of patients refractory or intolerant to methotrexate. However, in order to document the impact of the recent therapeutic progress on the prognosis of JIA there is the need to compare the long-term outcomes achieved with previous therapies with those obtained with the newer medications. We aimed to compare the level of disease activity and the amount of articular and extra-articular damage between patients treated in the “methotrexate” era and “biologic” eras.

Methods:  Data for the “methotrexate” era were extracted from a previous study on disease outcome in 310 patients with disease onset before 2002 and disease duration of ≥5 years (Solari et al. A&R 2008;59:1571-9). Data for the “biologic” era were obtained with the present study by examining all consecutive patients with JIA who had disease onset between January 2002 and June 2011 and a disease duration of ≥5 years. Outcome assessments included joint counts, physician global assessment of overall disease activity on a visual analog scale, Juvenile Arthritis Disease Activity Score-10 (JADAS10), Juvenile Arthritis Multidimensional Assessment Report (JAMAR) completed by a parent, and acute phase reactants. The amount of articular and extra-articular damage was assessed through the Juvenile Arthritis Damage Index (JADI).

Results:  Demographic and clinical features of patients seen in the two study periods were overall comparable. As compared to the older sample, patients treated more recently had received more frequently methotrexate (84.6 vs 64.5%) and biologic medications (60.4% vs 11.3%), and had undergone more commonly intra-articular corticosteroid injections (97.6% vs 79%). The comparison of disease activity and damage between the two cohorts is presented in the table. All items of JADI articular and extra-articular were decreased in the recent sample, with the exception of temporo-mandibular damage and leg-length discrepancy, whose frequency was comparable in the two datasets.    file:///C:/Users/23667/Desktop/Table.htm

Conclusion:  Compared with patients treated in the “methotrexate” era, those treated in the “biologic” era have a higher frequency of inactive disease and less articular and extra-articular damage. These findings highlight the improvement in disease outlook achieved with the newer therapeutic modalities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-activity-and-damage-in-juvenile-idiopathic-arthritis-comparison-between-methotrexate-and-biologic-era/