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Abstract Number: 2418

Pediatric Enthesitis-Related Arthritis: Variation in Disease Characteristics and Treatments Among 5 Large Centers

Sabrina Gmuca1, Timothy Brandon2, Rui Xiao3, Ilaria Pagnini4, Tracey B. Wright5, Timothy Beukelman6, Esi Morgan-DeWitt7 and Pamela F. Weiss8, 1Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, 2Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, 3Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, 4Department of Paediatrics, University of Florence and Anna Meyer Children's Hospital, Florence, Italy, Florence, Italy, 5Pediatrics/Rheumatology, Univ of TX Southwestern, Dallas, TX, 6Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 7Pediatric rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 8Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Clinical practice, enthesis, juvenile arthritis and spondylarthritis

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Session Information

Date: Tuesday, November 10, 2015

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects Posters (ACR): Imaging and Novel Clinical Interventions

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:
We aimed to compare the clinical features and treatments of children with
Enthesitis-related arthritis (ERA) from 5 pediatric rheumatology centers in
order to determine whether pediatric ERA manifests differently and/or is
treated differently based on geographical location.

Methods:
We
performed a retrospective multicenter cohort study that included subjects from
5 pediatric rheumatology centers who were diagnosed with ERA from 1989-2012. Baseline
visit for patients was defined as the first rheumatology appointment at which
the patient had enthesitis, arthritis, or symptomatic uveitis. To be included
in the study, patients had to fulfill the ILAR criteria for ERA within the
first 6 months from baseline visit. Patient data collected included the
following: demographics, clinical features, patient reported outcomes, and
medications prescribed at diagnosis and over the following 12 months. Differences across sites
were compared using the Kruskal-Wallis or chi-squared test, as appropriate.

Results:
296 children with ERA were included in the study. Patients were predominantly
male (69%) and Caucasian (83%). Median age at diagnosis was 12 years (IQR:
10-14) and 53% were HLA-B27 positive. The prevalence of arthritis and uveitis criteria
did not differ significantly across sites. The prevalence of the remaining
criteria, however, was significantly different across sites (all p<0.001): enthesitis
(range: 40-88%); sacroiliac tenderness or inflammatory lumbosacral pain (range:
10-55%); HLA-B27 positivity (range: 30-84%); onset of arthritis in a male over
6 years (range: 47-77%); and history of HLA-B27 associated disease in a
first-degree relative (range: 8-37%). The table shows medication use stratified
by site and clinical features. Overall use of DMARDs and biologics differed
significantly among sites (p<0.001 and p<0.001, respectively). Use of
biologics for arthritis (+/- enthesitis) and sacroiliitis (+/- peripheral
arthritis or enthesitis) also differed significantly among sites (p<0.001 and
p<0.001, respectively).

Conclusion:
Comparison of children with ERA from 5 pediatric rheumatology centers reveals significant
variability in the presenting features and initial treatment strategies.  The
variation in presenting features may reflect either true differences by
geographic location or differences between sites in assessment of particular
features. Biologic use was significantly different among sites for children
with arthritis and sacroiliitis. These differences highlight the need for standardized
assessments for ERA as well as comparative effectiveness studies of the
different treatment options.

 

Table. Medications Prescribed Within 3 Months of Initial ERA Clinical Feature

 

 

 

 

Medication

CLINICAL FEATURES WITHIN 3 MONTHS OF INITIAL PRESENTATION, N (%)

All subjects

Enthesitis, no arthritis

Peripheral arthritis +/- enthesitis

Sacroiliitis^ +/- enthesitis or peripheral arthritis

Uveitis

only

 

ALL SITES

296

18

235

40

3

No DMARD, no biologic†

134 (45)

17 (94)

110 (47)

6 (15)

1 (33)

DMARD

77 (26)

1 (6)

62(26)

14 (35)

0 (0)

Biologic+/- DMARD

85 (29)

0 (0)

63 (27)

20 (50)

2 (67)

SITE 1

118

14

 88

14

 2

No DMARD, no biologic†

56 (47)

13 (93)

39 (44)

3 (22)

1 (50)

DMARD

22 (19)

1 (7)

19 (22)

2 (14)

0 (0)

Biologic+/- DMARD

40 (34)

0 (0)

30 (34)

9 (64)

1 (50)

SITE 2

37

 0

 34

3

0

No DMARD, no biologic†

3 (8)

0 (0)

3 (9)

0 (0)

0 (0)

DMARD

9 (24)

0 (0)

9 (26)

0 (0)

0 (0)

Biologic+/- DMARD

25 (68)

0 (0)

22 (65)

3 (100)

0 (0)

SITE 3

20

1

10

8

1

No DMARD, no biologic†

5 (25)

1 (100)

3 (30)

1 (12)

0 (0)

DMARD

1 (5)

0 (0)

1 (10)

0 (0)

0 (0)

Biologic+/- DMARD

14 (70)

0 (0)

6 (60)

7 (88)

1 (100)

SITE 4

70

2

68

0

0

No DMARD, no biologic†

47 (67)

2 (100)

45 (66)

0 (0)

0 (0)

DMARD

18 (26)

0 (0)

18 (26)

0 (0)

0 (0)

Biologic+/- DMARD

5 (7)

0 (0)

5 (7)

0 (0)

0 (0)

SITE 5

51

1

35

15

0

No DMARD, no biologic†

23 (45)

1 (100)

20 (57)

2 (13)

0 (0)

DMARD

27 (53)

0 (0)

15 (43)

12 (80)

0 (0)

Biologic+/- DMARD

1 (2)

0 (0)

0 (0)

1 (7)

0 (0)

Legend. *Differences across sites were compared using the Kruskal-Wallis or chi-squared test, as appropriate. ^Sacroiliitis by imaging. †No DMARD, no biologic category includes patients treated with non-steroidal anti-inflammatories and/or intra-articular injection(s). DMARD: disease modifying anti-rheumatic drug.

 


Disclosure: S. Gmuca, None; T. Brandon, None; R. Xiao, None; I. Pagnini, None; T. B. Wright, None; T. Beukelman, UCB, 5,Genentech/Roche, 5,Novartis Pharmaceutical Corporation, 5; E. Morgan-DeWitt, None; P. F. Weiss, None.

To cite this abstract in AMA style:

Gmuca S, Brandon T, Xiao R, Pagnini I, Wright TB, Beukelman T, Morgan-DeWitt E, Weiss PF. Pediatric Enthesitis-Related Arthritis: Variation in Disease Characteristics and Treatments Among 5 Large Centers [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/pediatric-enthesitis-related-arthritis-variation-in-disease-characteristics-and-treatments-among-5-large-centers/. Accessed January 16, 2021.
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