Background The ACR paediatric criteria used in clinical trials are validated to analyse the response to a treatment in comparison to baseline but does not indicate the absolute disease activity nor the absolute improvement. This problem has been overcome by the development of the JADAS in 3 different versions.
Methods The JADAS10 and -71 has been used to analyse the efficacy of Etanercept treatment in JIA patients using data of the BIKER registry. It includes 4 measures: physician global assessment of disease activity, parent/patient global assessment of well-being, active joint count, and erythrocyte sedimentation rate.
Results A total 1470 JIA patients treated with Etanercept and followed by the GERMAN BIKER registry have been used for analysis. At baseline, patients with systemic JIA had highest JADAS71 (24.5±14.2; median 21, range 2-72) and JADAS10 (21.4±9.3; 21, 2-39), followed by RF+ polyarthritis (JADAS71 24.3±14; 22, 0-63; JADAS10 19.4±8.0; 20, 0-35) and RF- polyarthritis (JADAS71 23.1±14; 20, 0-85; JADAS10 18.4+/7.2; 18, 0-39). Patients with extended oligoarthritis had moderate JADAS71 (18.4±8.4) and -10 (17.5±7.3) at baseline, while patients with enthesitis related arthritis and psoriasis arthritis had lowest levels. The JADAS71 and the JADAS 10 (table 1) in the total JIA patient cohort markedly decreased. Patients of all JIA categories demonstrated improvement upon treatment within months. The residual disease activity (JADAS10; -71) remained highest in patients with systemic JIA (7.7; 9.3), RF+polyJIA (4.7; 5.0), RF-Poly (5.2; 5.9) and PsA (4.8; 5.4) while patients with extOligo, (2.6; 2.6), ERA (4.0; 4.1). No mayor differences were observed between the two scores. Patients treated with combination of Etanercept and Methotrexate at baseline had slightly higher JADAS71 and -10 score (21.2±12.5 and 18.1±7.0) than those receiving Etanercept monotherapy (10.3±10.1 and 16.8±7.4). At month 6, combination treatment resulted to a decrease of the JADAS71 and -10-score of 14.3±12.1 and 11.9±8.4 points and mono therapy to a decrease of 13.8±11.5 and 12.1±8.0 points which was comparable. At month 6 slightly more patients with Methotrexate achieved a JADAS score of 0 (21% vs.17%). At baseline, no obvious differences in JADAS71 or -10 was noted between those patients with a disease duration <2 years compared to those >2 years. While the decrease in both JADAS71 and -10 also ws comparable, more patients with a disease duration <2 years reached a JADAS of 0 (25% vs. 17.5%).
Conclusions The JADAS71 and JADAS10 scores could easily be performed and showed significant differences between the JIA categories. Patients of all JIA categories showed improvement, while those with a more serious disease also had highest residual disease activity. Positive effects of an early initiation of Etanercept treatment could also be demonstrated.
Disclosure of Interest G. Horneff Grant/Research support from: Pfizer, Abbott, Roche, T. Niehues: None Declared, H. Huppertz: None Declared, J. Haas: None Declared, K. Minden: None Declared
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