Department of Pediatric Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Pediatrics/Pediatric Rheumatology, Sophia Children's Hospital Erasmus Medical Center, J6-S, LUMC, PO Box 9600, 2300 RC, Leiden, Rotterdam, the Netherlands.
Pediatr Rheumatol Online J. 2019 Sep 4;17(1):62. doi: 10.1186/s12969-019-0362-1.
To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target.
Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration.
In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from - 0,82; 0.68), nor for BA (varying from - 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (- 1.48; - 0.68) compared to arm 1 (- 0.84; - 0.04) and arm 2 (- 0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1).
Recent-onset JIA patients, treated-to-target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment.
NTR, NL1504 (NTR1574). Registered 01-06-2009.
评估新发病的幼年特发性关节炎（JIA）患者在早期、严格控制、以目标为导向的治疗下的放射学进展。
参与 BeSt-for-Kids 研究的 JIA 患者，随机分为 3 种治疗策略组，如果至少有 1 张常规腕关节 X 线片可用，则符合条件。使用 Poznanski 评分评估腕骨长度反映的骨损伤。使用 BoneXpert 方法确定腕骨的骨龄（BA，> 5 岁）和骨密度（BMD）。使用线性混合模型评估这些评分随时间的变化，并根据年龄和症状持续时间进行校正后，比较治疗臂和平均 JADAS10 评分之间的差异。
在 60 名患者中，分析了 252 张 X 光片。各治疗臂的基线年龄和症状持续时间不同。与 Poznanski 评分（IQR 从-0.82 变化；0.68）和 BA（从-0.88 变化至 0.74）相比，基线时未发现与健康参考人群的差异。与臂 1（初始治疗用依那西普和甲氨蝶呤）相比，臂 3（初始治疗用依那西普和甲氨蝶呤）的基线 BMD 明显较低（-1.48；-0.68）（-0.84；-0.04）和臂 2（-0.93；0.15）。达到治疗目标后，疾病处于缓解状态，Poznanski 评分和 BA 保持不变，而臂 3 的 BMD 改善（与臂 1 相比，p < 0.05）。
新发病的 JIA 患者，以达到缓解疾病为目标的治疗，在基线或随访时均未显示腕关节放射学损伤的迹象（Poznanski 评分、BA 或 BMD），无论治疗臂如何。在臂 3 中，基线时 BMD 较低，初始使用甲氨蝶呤和依那西普治疗后，显著改善。
NTR，NL1504（NTR1574）。于 2009 年 6 月 1 日注册。
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