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The magnitude of early response to methotrexate therapy predicts long-term outcome of patients with juvenile idiopathic arthritis
  1. Manuela Bartoli (manuelabartoli{at}hotmail.com)
  1. IRCCS Policlinico S. Matteo, Pavia, Italy
    1. Marina Tarò
    1. IRCCS G. Gaslini, Genova, Italy
      1. Silvia Magni-Manzoni (s.magnimanzoni{at}smatteo.pv.it)
      1. IRCCS Policlinico S. Matteo, Pavia, Italy
        1. Angela Pistorio (angelapistorio{at}ospedale-gaslini.ge.it)
        1. IRCCS G. Gaslini, Genova, Italy
          1. Francesco Traverso
          1. IRCCS G. Gaslini, Genova, Italy
            1. Stefania Viola (stefaniaviola{at}ospedale-gaslini.ge.it)
            1. IRCCS G. Gaslini, Italy
              1. Alessandra Magnani (alessandramag{at}libero.it)
              1. IRCCS G. Gaslini, Italy
                1. Chiara Gasparini (chiaragasparini{at}yahoo.com)
                1. IRCCS Policlinico S. Matteo, Pavia, Italy
                  1. Alberto Martini (albertomartini{at}ospedale-gaslini.ge.it)
                  1. IRCCS G. Gaslini, Genova, Italy
                    1. Angelo Ravelli (angeloravelli{at}ospedale-gaslini.ge.it)
                    1. IRCCS G. Gaslini, Genova, Italy

                      Abstract

                      Objective: To investigate the relationship between the magnitude of clinical response in the first 6 months of methotrexate (MTX) therapy and the long-term outcome in children with juvenile idiopathic arthritis (JIA).

                      Methods: The clinical charts of 125 JIA patients who were started with MTX and were then followed for at least 5 years were reviewed. Based on the level of American College of Rheumatology (ACR) Pediatric response at 6 months, patients were divided in 4 mutually exclusive groups: 1) nonresponders; 2) responders at 30%; 3) responders at 50%; 4) responders at 70%. The long-term outcome in each response group was evaluated by calculating the percentage change in active and restricted joint counts from baseline to 1, 2 and 5 years and the frequency of inactive disease at 5 years.

                      Results: At 6 months, 42 patients were classified as nonresponders, 24 as 30% responders, 26 as 50% responders, and 33 as 70% responders. Patients who had achieved a 70% response showed a significantly greater percentage improvement in active joint count between baseline to 5 years compared with nonresponders and 30% responders, and a significantly greater percentage improvement in restricted joint count between baseline to 5 years compared with 30% responders. The 70% responders also had a greater frequency of inactive disease at 5 years compared with 30% responders.

                      Conclusions: Our results show that the achievement of an ACR Pediatric 70 response at 6 months after start of MTX therapy predicts a more favorable long-term outcome of patients with JIA.

                      • ACR Pediatric 30
                      • Juvenile idiopathic arthritis
                      • Long-term outcome
                      • Methotrexate
                      • Therapeutic response

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