Session Type: Abstract Submissions (ACR)
The 2011 ACR recommendations for the treatment of Juvenile Idiopathic Arthritis (ACR-JIA) are evidence-based, consensus-approved therapeutic pathways for the safe and effective treatment of JIA. Our aim was to determine the feasibility of applying ACR-JIA to evaluate the treatment pathway in a single centre JIA polyarthritis cohort.
We conducted a retrospective analysis of a single-centre paediatric JIA cohort by reviewing case notes, investigations and treatment databases of all newly diagnosed JIA polyarthritis patients in the 2 years after ACR-JIA publication. 35 patients with multiple joint arthritis fulfilled ILAR criteria for the diagnosis of JIA: systemic arthritis (n=5, analysed separately), polyarthritis (n=25) and Extended Oligoarthritis (n=5, analysed together with polyarthritis (total n=30) as these groups are managed similarly in the ACR Recommendations). Using the Recommendations, disease severity and poor prognostic features were used to categorize the patients and critical therapeutic time points (disease duration of 8-12 weeks from diagnosis to starting methotrexate, and if methotrexate was ineffective, 14-28 weeks from starting methotrexate to starting etanercept) were calculated. Drug monitoring frequency was also determined.
25 females and 10 males (median age at onset 13, range 1.5-15 years) were included in the evaluation. Median age at disease onset for poly/extended oligoarthritis was 10 years (1.5-16), with a median of 12 joints (12-38) active at presentation, and for the systemic group median age at onset was 6 years (2-7), with a median number of 6 active joints (2-10). 3 polyarthritis patients were rheumatoid factor positive. In the polyarthritis/extended oligoarthritis group, 2 patients with polyarthritis had poor prognostic features, 23 had moderate and 6 had high disease severity. None of the systemic patients had poor prognostic factors, 2 had moderate and 2 had high disease severity.
22/30 patients with polyarthritis/extended oligoarthritis followed the ACR recommendations for treatment according to their disease severity, commencing methotrexate therapy within a median of 6 weeks (3-32 weeks) of diagnosis. Etanercept was commenced in a total of 9 patients (30%) within a median of 6 months (1.5-24 weeks) subsequent to commencing methotrexate. This was due to intolerance in 5 patients (56%), inefficiency in 2 cases (22%) and both intolerance and inefficiency in 2 cases (22%). A total of 7 patients did not follow ACR-JIA guidelines due to excessive length of time between diagnosis and commencing methotrexate or etanercept treatment, most commonly due to delays in funding approval or insufficient regular drug monitoring tests. All patients with systemic arthritis followed the ACR-JIA recommendations.
Overall, 28/35 patients followed ACR-JIA. This study demonstrates the feasibility of using the ACR-JIA recommendations to evaluate a clinical pathway. It also highlights the potential influence of the local health economy in achieving rapid commencement of new JIA therapies and the challenges of ensuring regular drug monitoring in all patients.
T. R. Southwood,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/using-the-2011-acr-recommendations-for-the-treatment-of-juvenile-idiopathic-arthritis-jia-to-evaluate-a-single-centre-treatment-pathway-a-feasibility-study/