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The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort
  1. Jaime Guzman1,
  2. Kiem Oen2,
  3. Lori B Tucker1,
  4. Adam M Huber3,
  5. Natalie Shiff4,
  6. Gilles Boire5,
  7. Rosie Scuccimarri6,
  8. Roberta Berard7,
  9. Shirley M L Tse8,
  10. Kimberly Morishita1,
  11. Elizabeth Stringer3,
  12. Nicole Johnson9,
  13. Deborah M Levy8,
  14. Karen Watanabe Duffy10,
  15. David A Cabral1,
  16. Alan M Rosenberg4,
  17. Maggie Larché11,
  18. Paul Dancey12,
  19. Ross E Petty1,
  20. Ronald M Laxer8,
  21. Earl Silverman8,
  22. Paivi Miettunen9,
  23. Anne-Laure Chetaille13,
  24. Elie Haddad14,
  25. Kristin Houghton1,
  26. Lynn Spiegel8,
  27. Stuart E Turvey1,
  28. Heinrike Schmeling9,
  29. Bianca Lang3,
  30. Janet Ellsworth15,
  31. Suzanne Ramsey3,
  32. Alessandra Bruns5,
  33. Sarah Campillo6,
  34. Susanne Benseler9,
  35. Gaëlle Chédeville6,
  36. Rayfel Schneider8,
  37. Rae Yeung8,
  38. Ciarán M Duffy10
  39. for the ReACCh-Out investigators
    1. 1British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
    2. 2Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Canada
    3. 3IWK Health Centre and Dalhousie University, Halifax, Canada
    4. 4Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
    5. 5Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
    6. 6McGill University Health Centre and McGill University, Montreal, Canada
    7. 7London Health Sciences Centre and Western University, London, Canada
    8. 8Hospital for Sick Children and University of Toronto, Toronto, Canada
    9. 9The Alberta Children's Hospital and University of Calgary, Calgary, Canada
    10. 10Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
    11. 11McMaster University, Hamilton, Canada
    12. 12Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Canada
    13. 13Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada
    14. 14CHU Ste. Justine and Université de Montréal, Montréal, Canada
    15. 15The Stollery Children's Hospital and University of Alberta, Edmonton, Canada
    1. Correspondence to Dr Jaime Guzman, Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver BC, Canada V6H 3N1; jguzman{at}cw.bc.ca

    Abstract

    Objective To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments.

    Methods Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan–Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments.

    Results In a cohort of 1104 children, the probabilities of attaining an active joint count of 0 exceeded 78% within 2 years in all JIA categories. The probability of attaining inactive disease exceeded 70% within 2 years in all categories, except for RF-positive polyarthritis (48%). The probability of discontinuing treatment at least once was 67% within 5 years. The probability of attaining remission within 5 years was 46–57% across JIA categories except for polyarthritis (0% RF-positive, 14% RF-negative). Initial treatment included joint injections and non-steroidal anti-inflammatory drugs for oligoarthritis, disease-modifying antirheumatic drugs (DMARDs) for polyarthritis and systemic corticosteroids for systemic JIA.

    Conclusions Most children with JIA managed with contemporary treatments attain inactive disease within 2 years of diagnosis and many are able to discontinue treatment. The probability of attaining remission within 5 years of diagnosis is about 50%, except for children with polyarthritis.

    • Epidemiology
    • Juvenile Idiopathic Arthritis
    • Outcomes research
    • Treatment

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