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Major improvements in health-related quality of life during the use of etanercept in patients with previously refractory juvenile idiopathic arthritis
  1. F H M Prince1,
  2. L M Geerdink1,
  3. G J J M Borsboom2,
  4. M Twilt1,
  5. M A J van Rossum3,4,
  6. E P A H Hoppenreijs5,
  7. R ten Cate6,
  8. Y Koopman-Keemink7,
  9. M van Santen-Hoeufft8,
  10. H Raat2,
  11. L W A van Suijlekom-Smit1
  1. 1
    Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
  2. 2
    Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  3. 3
    Department of Paediatrics/Paediatric Rheumatology, Emma Children’s Hospital AMC, Amsterdam, The Netherlands
  4. 4
    Department of Paediatric Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  5. 5
    Department of Paediatrics/Paediatric Rheumatology, Radboud University Nijmegen Medical Centre, The Netherlands
  6. 6
    Department of Paediatrics/Paediatric Rheumatology, Leiden University Medical Centre, The Netherlands
  7. 7
    Department of Paediatrics/Paediatric Rheumatology, Hagaziekenhuis Juliana Children’s Hospital, Den Haag, The Netherlands
  8. 8
    Department of Internal Medicine, subdivision Rheumatology, Academic Hospital Maastricht, The Netherlands
  1. Correspondence to F H M Prince, Department of Paediatrics/Paediatric Rheumatology, Sp 1546, Erasmus MC Sophia Children’s Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands; f.prince{at}


Objective: To evaluate changes in health-related quality of life (HRQoL) in patients with refractory juvenile idiopathic arthritis (JIA) who are being treated with etanercept.

Methods: 53 patients with JIA from seven Dutch centres were included. HRQoL was measured by the Childhood Health Assessment Questionnaire (CHAQ), Child Health Questionnaire (CHQ) and Health Utilities Index mark 3 (HUI3) at the start and after 3, 15 and 27 months of treatment. At the same time points the following JIA disease activity variables were collected; physician’s global assessment through the visual analogue scale (VAS), number of active and limited joints and erythrocyte sedimentation rate. A statistical method linear mixed models was used to assess outcomes over time.

Results: During etanercept treatment both disease-specific and generic HRQoL outcomes improved dramatically. Significant improvements were shown after 3 months and these improvements continued at least up to 27 months of treatment. The disease-specific CHAQ, including VAS pain and wellbeing, showed a significant improvement in all domains. The generic health-profile measure CHQ improved for all the health concepts except for “family cohesion”, which was normal. The generic preference-based HUI3 showed impairment and, subsequently, significant improvement in the more specific domains (“pain”, “ambulatory”, “dexterity”). In accordance disease activity variables also improved significantly over time.

Conclusion: This study shows that the HRQoL of patients with refractory JIA can be substantially improved by the use of etanercept for all aspects impaired by JIA. Information on HRQoL is crucial to understand the complete impact of etanercept treatment on patients with JIA and their families.

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  • ▸ Additional data are published online only at

  • Funding Board of Health Insurances and Wyeth International.

  • Competing interests Wyeth International has financially supported the development and maintenance of the web-based ABC register since 2007.

  • Neither the Board of Health Insurances nor Wyeth International had any role in the design and conduct of the interpretation of the data; or preparation, review, or approval of the manuscript. Researchers are independent of the sponsors.

  • Ethics approval Approval from the medical ethical committee of Erasmus MC, Rotterdam and the local medical ethical committee was given in every participating centre.

  • Provenance and Peer review Not commissioned; externally peer reviewed.