ObjectiveBased on a nationwide database, this study analyzed the influence of methotrexate (MTX), tumor necrosis factor (TNF) inhibitors, and a combination of the 2 medications on uveitis occurrence in juvenile idiopathic arthritis (JIA) patients.MethodsData from the National Paediatric Rheumatological Database in Germany were used in this study. Between 2002 and 2013, data from JIA patients were annually documented at the participating pediatric rheumatologic sites. Patients with a JIA disease duration of <12 months at initial documentation and ≥2 years of followup were included in this study. The impact of antiinflammatory treatment on the occurrence of uveitis was evaluated by discrete‐time survival analysis.ResultsA total of 3,512 JIA patients (mean ± SD age 8.3 ± 4.8 years, 65.7% female, 53.2% antinuclear antibody positive, and mean ± SD age at arthritis onset 7.8 ± 4.8 years) fulfilled the inclusion criteria. Mean ± SD total followup time was 3.6 ± 2.4 years. Uveitis developed in a total of 180 patients (5.1%) within 1 year after arthritis onset. Uveitis onset after the first year was observed in another 251 patients (7.1%). Disease‐modifying antirheumatic drug (DMARD) treatment in the year before uveitis onset significantly reduced the risk for uveitis as follows: MTX: hazard ratio (HR) 0.63, P = 0.022; TNF inhibitors: HR 0.56, P < 0.001; and a combination of the 2 medications: HR 0.10, P < 0.001. Patients treated with MTX within the first year of JIA had an even a lower uveitis risk (HR 0.29, P < 0.001).ConclusionThe use of DMARDs in JIA patients significantly reduced the risk for uveitis onset. Early MTX use within the first year of disease and the combination of MTX with a TNF inhibitor had the highest protective effect.

T1D occurs more frequently in patients with JIA than in the general population. The likelihood of T1D occurrence appears to be slightly higher before JIA manifestation and without disease-modifying antirheumatic drug therapy after JIA onset.

The prevalence of overweight in JIA was comparable to the general population and decreased significantly over time. The decrease was associated with higher functional ability and JIA patients should be encouraged to be more physically active. The role of an elevated body mass index (BMI) in the long-term outcome of JIA needs to be addressed in future studies.

BackgroundThe majority of JIA categories are considered as autoimmune diseases. Autoimmune diseases seem to cluster in children and adolescents with JIA, which is attributed to shared susceptibility genes. Studies revealed an increase in the simultaneous JIA and juvenile type 1 diabetes mellitus (T1D) occurrence and an increased JIA prevalence in patients with T1D [1]. However, the frequency of T1D in JIA patients in comparison to the general population is unknown.ObjectivesTo determine the frequency of T1D in JIA patients and to characterize patients having both JIA and T1D.MethodsDiabetes comorbidity was recorded in the national paediatric rheumatologic database (NPRD) in 2012 and 2013. Data of the North Rhine-Westphalian diabetes register and the Diabetes data acquisition system for prospective surveillance (DPV) served as reference for the diabetes prevalence in the general population. NPRD data were indirectly standardized for age and sex for the comparison with the general population. The diabetes prevalence ratio (PR) was calculated using Poisson regression models.Results9,359 JIA patients were included in the analyses. Patient mean age was 12 years (SD 4.5), mean disease duration 4.5 years (SD 3.8). 50 patients had T1D in addition to JIA, diabetes prevalence was 0.5%. Patients with versus without T1D did not differ significantly in the JIA category spectrum. Compared to the general population, the diabetes prevalence in JIA patients was significantly increased (PR: 1.96 [CI: 1.49;2.59], p<0.001). The PR for diabetes for girls was 1.92 (CI: 1.35;2.73, p<0.001) and for boys 2.04 (CI: 1.30;3.19, p=0.002). Diabetes onset in JIA patients was slightly earlier than in the age- and sex-matched population. More than half of the patients (58%) developed diabetes before JIA. Diabetes onset was on average 60 months before the JIA onset. Patients with JIA before T1D developed T1D on average 35 months after JIA onset. The majority of these patients had not received any DMARDs before diabetes onset.ConclusionsDiabetes type 1 occurs more frequently in JIA patients than in the general population. The likelihood of T1D seems to be slightly higher before JIA manifestation and in patients who were not treated with DMARDs after JIA onset.The NPRD has been funded by the German Children Arthritis Foundation (Deutsche Kinder-Rheumastiftung).ReferencesHermann G, Thon A, Mönkemoller K, Lilienthal E, Klinkert C, Holder M et al. Comorbidity of type 1 diabetes and juvenile idiopathic arthritis. J Pediatr 2015;166:930–5.Disclosure of InterestNone declared

BackgroundUveitis is one of the most threatening complications in juvenile idiopathic arthritis (JIA). It occurs in approximately 10% of cases and may lead to severe vision loss. There is preliminary evidence from a retrospective study that early DMARD treatment can prevent uveitis.ObjectivesTo determine the frequency of incident uveitis in patients with JIA during the first years of disease and its influencing factors.MethodsData source for this analysis was the National Paediatric Rheumatological Database (NPRD). Patients with early JIA (disease duration <12 months) were considered, if they were enrolled in the NPRD between the years 2002 and 2012, had no history of uveitis at inclusion and were prospectively followed for at least one year. Disease characteristics and details on treatment were provided by rheumatologists once a year along with patient-reported outcomes. The association of anti-inflammatory treatment with the occurrence of uveitis in follow-up was evaluated by discrete survival analysis.Results3,512 JIA patients fulfilled the inclusion criteria and were considered in the analysis. At first documentation in the NPRD, the patients had a median disease duration of 6 months and were treated with DMARDs in 35%, namely with methotrexate (MTX) in 29% and with biologics in 2%.During the mean observation time of 3.3±2.3 years (range 2-11), 431 (12.3%) of the patients developed uveitis. In 251 cases (58.2%), first uveitis manifestation occurred after enrollment in the NPRD. These patients were younger at JIA onset (4.9 vs. 8.1 years), more often ANA positive (73.1% vs. 49.6%), and had more often oligoarthritis (63.4% vs. 51.6%) than those who never experienced uveitis during the observation period. Patients who received DMARDs experienced subsequently less frequently uveitis than those who weren't treated with DMARDs. In fact, patients on MTX (n=1,224) and biologics (n=308) treatment had a significantly reduced risk of uveitis (HR 0.73, p=0.017 and HR 0.50, p=0.006, respectively) compared to those who were not treated with MTX and biologicals in the year before uveitis diagnosis.After the diagnosis of uveitis, patients were treated significantly more often with MTX (OR 3.7, p<0.001) or MTX and biologicals (OR=4.9, p<0.001) compared to patients without uveitis.ConclusionsThis prospective population-based observational cohort study corroborates published data on a JIA-associated uveitis frequency of 12% in Central Europe. In addition to specific disease characteristics (e.g., disease onset after the age of 6, ANA negativity, and a disease category other than oligoarthritis), early treatment with DMARDs seems to be associated with a lower risk of uveitis in JIA patients.AcknowledgementsThe study was supported by an unrestricted grant from Pfizer Pharma GmbH Germany (Forschungsförderung Rheumatologie). The national pediatric database is financially supported by the Children's Arthritis Foundation (Kinder-Rheumastiftung).Disclosure of InterestC. Tappeiner Grant/research support from: Swiss Foundation for Grants...