Juvenile Idiopathic Arthritis (JIA) is a heterogeneous disorder. The ILAR classification for JIA consists of 8 subtypes. Since the etiology of JIA is unknown this classification is mostly based on clinical phenotypes. Obviously these subtypes respond to treatment differently. A large retrospective UK cohort study showed that baseline demographic, clinical and routine laboratory parameters cannot predict disease outcome. To study response to treatment, clinical homogenous JIA subtype cohorts must be formed using validated clinical parameters and novel biomarkers. Also, stopping strategies should be employed for drugs for patients in clinical remission, induced by that drug. We recently proposed a prediction model for response (and non- response) to MTX including clinical variables, ESR and SNPs in genes coding for pathways involved in MTX metabolism. This prediction model may help to identify JIA patients not responding to MTX treatment, thus assisting clinicians in making individualised treatment decisions. Response to treatment depends on subtypes but may also depend on disease duration before a drug is initiated. Especially in SJIA drug responses seem to be more successful when started early, thus supporting the concept of a window of opportunity. Also in such strategies early withdrawal of medication after induction of remission seems more successful. However these assumptions need to be validated in larger cohorts.
Disclosure of Interest None Declared
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