Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey.
Division of Rheumatology, Department of Internal Medicine, Ankara Training and Research Hospital, 06230-Altındağ, Ankara, Turkey.
Eur J Pediatr. 2024 Jun;183(6):2725-2731. doi: 10.1007/s00431-024-05538-y. Epub 2024 Mar 30.
The purpose of this study was to compare the demographic and clinical characteristics of the groups with and without bDMARDs added to the treatment of persistent oligoarticular juvenile idiopathic arthritis (JIA) patients on methotrexate (MTX) and also to determine the predictors of adding bDMARDs to treatment. This study included 86 oligoarticular JIA patients on MTX. Patients were divided into two groups receiving MTX (n = 69) and MTX plus bDMARD (n = 17). Predictors of adding bDMARDs were investigated by comparing demographic, clinical features and laboratory findings. Gender, age at diagnosis, time elapsed from the onset of symptoms to diagnosis, and disease duration, the number and distribution of affected joint at the time of diagnosis were similar in both groups. The mean JADAS10 at the time of diagnosis were 18.8 ± 4.2 and 19.5 ± 6.4 in the MTX and MTX plus bDMARDs groups, respectively (p = 0.68). JADAS10 at 3rd and 6th month were significantly higher in patients on MTX plus bDMARDs (p = 0.001, p = 0.004, respectively). In multivariate analysis, the risk of adding bDMARD was shown to increase 1.24-fold (p = 0.004, 95% CI: 1.07-1.43) for each point increase on the JADAS 10 at 3rd months. The number (p = 0.64) or type (p = 0.18) of joint involvement at disease onset were not predictors of adding a bDMARD.
JADAS10 indicating ongoing severe disease activity at 3rd and 6th months rather than baseline JADAS10 is associated with the addition of bDMARDs.
• Oligoarticular JIA patients have the best outcomes among JIA categories and respond favorably to first-line therapies such as non-steroidal anti-inflammatory drugs and intraarticular corticosteroid injections. • Clinically inactive disease rates have increased with the widespread use of biological agents in oligoarticular JIA patients who have not responded to initial therapies.
• Approximately one-fifth of patients with persistent oligoarticular JIA on methotrexate may require the addition of a biological disease modifying anti-rheumatic drug during follow-up. • The JADAS10 calculated at 3 and 6 months is a valuable tool to identify patients who should be added biological disease modifying anti-rheumatic drugs in persistent oligoarticular JIA.
本研究旨在比较在甲氨蝶呤（MTX）治疗下持续性少关节炎型幼年特发性关节炎（JIA）患者加用生物改善病情抗风湿药物（bDMARDs）与未加用 bDMARDs 治疗的两组患者的人口统计学和临床特征，并确定加用 bDMARDs 的预测因素。
本研究纳入了 86 例接受 MTX 治疗的少关节炎型 JIA 患者。患者分为两组：接受 MTX 治疗（n=69）和 MTX 联合 bDMARD 治疗（n=17）。通过比较人口统计学、临床特征和实验室检查结果，探讨加用 bDMARDs 的预测因素。
两组患者的性别、诊断时年龄、从症状出现到诊断的时间间隔、疾病持续时间、诊断时受累关节的数量和分布均相似。MTX 组和 MTX 联合 bDMARD 组患者诊断时 JADAS10 的平均值分别为 18.8±4.2 和 19.5±6.4（p=0.68）。MTX 联合 bDMARD 组患者在第 3 个月和第 6 个月时 JADAS10 显著升高（p=0.001，p=0.004）。多变量分析显示，第 3 个月 JADAS10 每增加 1 分，加用 bDMARD 的风险增加 1.24 倍（p=0.004，95%CI：1.07-1.43）。疾病发作时受累关节的数量（p=0.64）或类型（p=0.18）均不是加用 bDMARD 的预测因素。
第 3 个月和第 6 个月 JADAS10 提示持续严重疾病活动，而非基线 JADAS10 与加用 bDMARDs 相关。
