Objectives: To examine the change in health-related quality of life (HRQOL) and its determinants in children with juvenile idiopathic arthritis (JIA) treated with methotrexate (MTX).
Methods: Patients were extracted from the PRINTO clinical trial aimed to evaluate the efficacy and safety profile of MTX administered in standard, intermediate or higher doses (10, 15 and 30 mg/m2/week respectively). Children with polyarticular-course JIA, who were less than 18 years and had a complete HRQOL assessment were included.
Results: A total of 521 children were included. At baseline, JIA patients showed poorer HRQOL (p<0.01) as compared to healthy children. In 207/412 (50%) and 63 (15%) children, HRQOL values were 2 standard deviation from the mean of healthy controls in the physical and psychosocial summary scale, respectively. After 6 months of therapy with standard-dose MTX, there was a statistical significant improvement in all HRQOL health concepts, particularly in the physical ones. Similar improvements were observed in the patients non-responders to standard dose MTX who were subsequently randomized to higher dose-MTX. The presence of marked disability at baseline was associated with a 5-fold increased risk to maintain a poor physical health after 6 months of active treatment with standard-dose MTX. Other less important determinants for maintenance of poor physical well being were the baseline level of systemic inflammation, the intensity of child’s pain and an ANA-negative status.
Conclusions: We report that MTX treatment produces a significant improvement across a wide range of HRQOL components, particularly in the physical domains, in patients with JIA.
- health related quality of life
- juvenile idiopathic arthritis