Background At least one third of the JIA patients as a whole experience a polyarticular course of disease which carries a high risk of persistent disease activity and disability. However, new therapeutic strategies hold promise for a better short- and long-term outcome of these patients.
Objectives To examine changes in treatment and health status of patients with pJIA treated by paediatric rheumatologists over the past 12 years.
Methods Data of patients with pJIA (rheumatoid factor [RF]-negative polyarthritis [PA], RF-positive PA, extended oligoarthritis), who were prospectively recorded in the national paediatric rheumatologic database in the years from 2000 to 2011, were considered for this analysis. The health status assessment of patients included physician- and patient/parent-reported outcomes: disease activity (measured by JADAS-10), functional capacity (measured by the CHAQ), pain and overall well-being (both measured by numeric rating scales from 0 to 10). Per year, a mean value was calculated for each health status parameter, with the patients recorded each year adjusted for age, sex, disease duration, treatment (MTX, biologics, corticosteroids), and time. The change of disease parameters over time and the influence of treatment on change were assessed by linear mixed models.
Results Altogether, 10,310 cases with pJIA were recorded; the number of yearly included patients increased from 594 in 2000 to 1,517 in 2011. Over the years, the patients were treated increasingly more often with DMARDs in general and with biologics in particular. While in the year 2000, 70% and 2% of patients were treated with DMARDs and biologics, these were 79% and 32% in the year 2011, respectively. Moreover, pJIA patients were treated earlier in the disease course. In 2000, 52% and 1% received MTX and/or biologics during the first 12 months of the disease, in 2011 68% and 19%, respectively. Changes in treatment were coincided by changes in the health status of patients. Over the years, the adjusted mean annual JADAS-10 score significantly decreased from 10.3 to 8.1 (p=0.042), the CHAQ-score almost halved from 0.45 to 0.26 (p<0.001). The adjusted mean annual pain value also significantly decreased over time (p=0.024), and the patients´ overall well-being improved (p=0.017). A significant correlation was found between DMARD and biologic use and the decrease of disease activity (beta=-0.12) and functional restrictions over time (beta=-0.02), respectively.
Conclusions Along with the increasing and earlier use of DMARDs, especially of biologic drugs, the health status of patients with pJIA treated by paediatric rheumatologists has improved during the last decade.
Acknowledgements The national database has been funded by the Kinderrheumastiftung (child arthritis foundation).
Disclosure of Interest K. Minden Grant/research support from: Pfizer, AbbVie, M. Niewerth: None Declared, G. Horneff Grant/research support from: Pfizer, AbbVie, Roche, A. Thon: None Declared, G. Ganser: None Declared, I. Foeldvari Grant/research support from: Actelion, J. Klotsche: None Declared