Background/Purpose: The concept of Health-related quality of life (HrQoL) has been widely accepted as a burden of disease measure in recent years. The improvement in HrQoL is an important therapy goal in the treatment of patients with juvenile idiopathic arthritis (JIA). We investigated the 12-month course of HrQol in an unselected cohort of patients with JIA after therapy start with Etanercept and identified its associated factors.

Methods: Children were enrolled in the BiKer (Biologics in Paediatric Rheumatology) registry. A random subset of children completed the Pediatric Quality of Life Inventory (PedsQL) after the start of Etanercept treatment and was followed-up monthly for 6 monthly and bimonthly thereafter for up to one year. The 12-month course of the PedsQL total score and predictors for the change in HrQoL were investigated by growth curve modeling. The role of the depending predictor variables of an inactive disease and level of pain were studied in the course of HrQoL. The criteria by Wallace (2004) were applied to define inactive disease, the level of pain was assessed on a visual analogue scale (0-100) and functioning was measured by the CHAQ.

Results: Data were available for 61 patients with a mean age of 10.5 years (sd=3.9) and a mean disease duration of 3.2 years (sd=3.2). At baseline, the mean PedsQL total score was 75.5 (sd=16.7), mean number of swollen joints was 7.2 (sd=6.2), the mean rating of disease activity was 56.9 (sd=19.5) and 80% of the children reported functional restrictions indicated by a CHAQ above 0. A lower HrQol for patients at baseline was significantly associated with the number of swollen joints (beta=-1.1, p=0.016), functional restrictions (beta=-18.9, p<0.001), a high disease activity (beta=-0.31, p=0.002) and the existence of at least one comorbid condition (beta=11.5, p=0.021). The PedsQL total score increased at a rate of 2.8 units per month (p<0.001) in the first 6 months of treatment up to a level of 89.7 (sd=10.7), whereas the increase flattened (0.3 units per month, p=0.144) from 6-month to 12-month follow-up. A total of 16 (26%) children were already in remission after one year Etanercept treatment. The achievement of remission at the second month (beta=6.7, p<0.001) and fourth month (beta=5.2, p=0.029) yielded a significant increase in HrQoL. A high level of pain was associated with a lower HrQoL at each occasion.

Conclusion: HrQoL significantly improved after starting an Etanercept therapy in children with JIA. Adequate disease control and a low level of pain predicted a higher HrQoL in the 12-month course. But, both time dependent predictor variables did not fully explain the improvement in HrQoL.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-in-health-related-quality-of-life-for-children-with-juvenile-ideopathic-arthritis-after-start-of-treatment-with-etanercept/