ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2432

The Preventive Effect of Methotrexate on Uveitis Onset in JIA Depends on Uveitis Risk Factors

Mikhail Kostik1, Ekaterina Gaidar1, Margarita Dubko1, Ludmila Snegireva2, Vera Masalova2, Irina Chikova1, Eugenia Isupova3, Tatiana Nikitina4, Elena Serogodskaya1, Olga Kalashnikova1, Angelo Ravelli5 and Vyacheslav Chasnyk3, 1State Pediatric Medical University, Saint-Petersburg, Russia, 2Hospital Pediatrics, State Pediatric Medical University, Saint-Petersburg, Russia, 3Hospital Pediatry, State Pediatric Medical University, Saint-Petersburg, Russia, 4State Pediatric Medical University, St. Petersburg, Russia, 5Pediatria-II, IRCCS G. Gaslini and University of Genova, Genova, Italy

Meeting: ACR/ARHP Annual Meeting 2015

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Tuesday, November 10, 2015

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:

Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA), often entirely asymptomatic but could be sight-threatening. The main predictors of uveitis in JIA are oligoarticular (OA) subtype, ANA-positivity and younger age at the JIA onset. Methotrexate (MTX) has been able to decrease the incidence of uveitis in JIA up to 2 times [1].

Objectives:To evaluate the possibility of MTX to prevent the onset of uveitis in different JIA subgroups according to the main uveitis risk factors.

Methods:

The clinical charts of all consecutive patients who had received a stable management for at least 2 years with or without MTX were reviewed. Patients who were given systemic medications other than MTX (except NSAID) were excluded. Patients with systemic arthritis, rheumatoid factor-positive arthritis, or enthesitis-related arthritis were also excluded. In each patient, the al least 2-year follow-up period after first visit was examined to establish whether uveitis had occurred. MTX was administered in the subcutaneous injections in the dosage 15 mg/m2/week.

Results:

A total of 281 patients with a median disease duration of 3.8 year were included. One hundred and ninety one patients (68%) were treated with MTX compare to 33.9% in previous study [1]. During the at least 2-year follow-up, 64 patients (22.8%) developed uveitis, a median of 1.6 year after the disease onset. The frequency of uveitis was lower in MTX-treated than in MTX-untreated patients (11.5% vs 46.7%, respectively, OR=6.7 (95%CI:3.7-12.3), p= 0.0000001). In previous study the frequency of uveitis was 10.5 in MTX-treated vs 20.2 in MTX-untreated patients [1]. Survival analysis confirmed that patients treated with MTX had a lower probability of developing uveitis (HR=4.35, p=0.000001). The results of preventive effect of MTX in different JIA subgroups, according to the main uveitis risk factors are shown in the table 1.

 Table 1. The ability of MTX to prevent uveitis in different subgroup.

Group

MTX, Y/N

Rate (%)

OR (95% CI)

p†

HR*

p§

Boys

N

9/26 (34.6)

7.3 (2.0-26.6)

0.001*

6.7

0.0007

Y

4/59 (6.8)

Girls

N

19/132 (14.4)

5.9 (3.0-11.9)

0.000001

3.6

0.000001

Y

32/64 (50.0)

Oligoarticular course

N

37/81 (45.7)

5.7 (2.9-11.3)

0.000001

4.0

0.000001

Y

16/125 (12.8)

Polyarticular course

N

4/9 (44.4)

6.7 (1.5-31.2)

0.007

3.7

0.02

Y

7/66 (10.6)

ANA (+)ve

N

20/29 (68.9)

10.1 (3.6-28.1)

0.000002

4.4

0.00002

Y

11/61 (18.0)

ANA (-)ve

N

13/43 (30.2)

4.4 (1.7-11.8)

0.0016

3.6

0.003

Y

8/90 (8.9)

Age of JIA onset ≤ 5 y

N

23/57 (40.4)

3.5 (1.7-7.3)

0.0006

2.3

0.003

Y

18/111 (16.2)

Age of JIA onset > 5 y

N

15/47 (31.9)

20.6 (4.5-95.2)

0.000001

22.2

0.000001

Y

2/90 (2.2)

† χ2-test, §Log-Rank test, * Cox regression models

Conclusion:

Conclusions:MTX therapy may differently prevent the onset of uveitis in children with JIA depends on uveitis risk factors. Further randomized controlled trial required to confirmation our results.

References:

1.Papadopoulou C, Kostik M, Bohm M, Nieto-Gonzalez JC, Gonzalez-Fernandez MI,  Pistorio A, Martini A, Ravelli A. Methotrexate Therapy May Prevent the Onset of Uveitis in Juvenile Idiopathic Arthritis. J Pediatr 2013;163:879-84

Disclosure: M. Kostik, None; E. Gaidar, None; M. Dubko, None; L. Snegireva, None; V. Masalova, None; I. Chikova, None; E. Isupova, None; T. Nikitina, None; E. Serogodskaya, None; O. Kalashnikova, None; A. Ravelli, Abbvie, Novartis, Pfizer, 8,Novartis Pharmaceutical Corporation, Roche, 5; V. Chasnyk, None.

To cite this abstract in AMA style:

Kostik M, Gaidar E, Dubko M, Snegireva L, Masalova V, Chikova I, Isupova E, Nikitina T, Serogodskaya E, Kalashnikova O, Ravelli A, Chasnyk V. The Preventive Effect of Methotrexate on Uveitis Onset in JIA Depends on Uveitis Risk Factors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-preventive-effect-of-methotrexate-on-uveitis-onset-in-jia-depends-on-uveitis-risk-factors/. Accessed .

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