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Abstract Number: 292

Flares in Children with JIA: Results from the Reacch-out Cohort

Lori B. Tucker1, Jaime Guzman1, Kiem Oen2 and ReACCh Out Investigators3, 1Rheumatology, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada, 2Pediatrics, Children's Hospital of Winnipeg and University of Manitoba, Winnipeg, MB, Canada, 3BC Children's Hospital, Vancouver, BC, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: juvenile idiopathic arthritis (JIA) and pediatric rheumatology

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Session Information

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:   Disease flares are a concern to patients with JIA, their parents, and caregivers alike; but little is known of disease manifestations during a flare in children who have achieved inactive disease (ID) or whether flares differ among subtypes.  The aim of this study is to describe flares in children with JIA and determine differences in flare characteristics among JIA subtypes. 

Methods:    We studied children diagnosed with JIA between 2005 and 2010 who had at least one visit with ID (no active joints, no extra-articular manifestation, and a physician global assessment < 10mm) while being prospectively followed in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. They received usual pediatric rheumatology care at 16 Canadian centres.  Flare was defined as loss of any criteria for ID. In addition a flare was imputed on the basis of an intra-articular injection alone in absence of other documentation of disease activity.  Treatment of flares were recorded if there was a change, addition, or restart of anti-rheumatic or anti-uveitis treatment.

Results: Of 1492 children recruited in ReACCh-Out, 1146 had at least one visit with ID, with median follow-up of 24 mo (IQR 12,39) following first record of ID.   A total of 1,191 flares were observed in 531 children (46.3%) after their first ID episode: 31% with systemic  JIA and 44-50% with other subtypes.   Arthritis was a feature of the majority of flares but there were significant differences in frequencies across subtypes (p=0.001).  Frequencies of nonarticular flares also differed among subtypes (p<0.001) and were most common in children with systemic, enthesitis related arthritis and undifferentiated subtypes.  Flares due to uveitis were seen in patients with oligoarticular, rheumatoid factor negative, and undifferentiated subtype most commonly.  The majority of flares occurred while patients were still on treatment for their JIA and overall 45% were not associated with treatment changes (Table).

Table:  Characteristics of disease flare across JIA subtypes

Feature

All

Systemic

Oligo

RF neg

RF pos

Psoriatic

ERA

Undiff

# subjects

1146

68

488

212

35

75

155

113

# subjects with flare

531

21

232

106

17

36

69

50

# flares

1191

82

483

233

56

70

133

134

Flare signs (% of flares):

 

 

 

 

 

 

 

 

  Arthritis flares

79

58.5

83

85

93

86

63

72

  Non-articular

  flares

18

41.5

13

12

7

14

35

22

  PGA ≥ 1 without

  other signs

10

29

8

7

7

9

13.5

7.5

Treatment at time of flare (% of flares):

 

 

 

 

 

 

 

 

  Flare on treatment

70

91.5

56.5

83

86

60

78

71

  Flare off  treatment

27

7

39

15.5

14

40

19.5

25

  No change in

  treatment

  following flare

45

66

40

48

50

46

48

37

Conclusion:  Flare characteristics in JIA differ among disease subtypes.  An increase in PGA alone accounts for flare some patients, suggesting that PGA includes consideration of disease manifestations not included in our flare definition.  Our results suggest that while disease flares occur in approximately half of children with JIA managed with usual care, many are mild and require no treatment change.


Disclosure:

L. B. Tucker,
None;

J. Guzman,
None;

K. Oen,
None;

R. O. Investigators,
None.

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