Current Medical Treatments for Juvenile Idiopathic Arthritis

Ruperto, Nicolino; Martini, Alberto

doi:10.3389/fphar.2011.00060

Cited by 19 publications

(10 citation statements)

References 64 publications

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“…Furthermore, it is desirable to identify patients with a high likelihood of developing erosive joint damage early, so as to institute appropriately aggressive therapy at an early stage of the disease. Of the diagnostic tools currently available, imaging studies are best suited for these purposes (Ruperto and Martini, 2011) [17].…”

Section: Discussionmentioning

confidence: 99%

Implementation of musculoskeletal ultrasonography in detection of early juvenile idiopathic arthritis

Darwish

ismael

Ell-Laban

et al. 2016

European Journal of Radiology Open

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AimTo determine whether early clinical, laboratory and musculoskeletal ultrasound (MSUS) characteristics can be used as early detectors of juvenile idiopathic arthritis.Patients and methodsForty (40) patients with juvenile idiopathic arthritis (JIA) diagnosed according to the ILAR criteria [1] and 20 healthy control children. All patients were subjected to the following assessment at base line and at follow up after 6 months: Clinical evaluation, MSUS examination and laboratory evaluation.ResultsOf the 40 patients, 6 patients (15%) had systemic onset subtype, 8 (20%) oligoarticular extended, 9 (22.5%) oligoarticular persistent, 5 (12.5%) polyarticular rheumatoid factor (RF) +ve, 6 (15%) polyarticular RF −ve, 5 (12.5%) enthesitis related subtype and only one patient (2.5%) had psoriatic JIA. MSUS detected more synovitis than clinical examination (subclinical synovitis) both at base line and at follow up. MSUS is highly sensitive for early detection of joint involvement in JIA when compared to physical examination. Significant decrease in the mean cartilage thickness of the patients measured at follow up as compared to measures at base line.ConclusionMSUS is highly sensitive for early detection of joint involvement in JIA when compared to physical examination

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Section: Discussionmentioning

confidence: 99%

Implementation of musculoskeletal ultrasonography in detection of early juvenile idiopathic arthritis

Darwish

ismael

Ell-Laban

et al. 2016

European Journal of Radiology Open

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“…The intro duction of biological DMARDs has improved patient outcomes, and many more children now reach adulthood without substantial joint damage or complications from persistent uveitis compared with the pre-biologic era. 1,2 Tumour necrosis factor inhibitors (TNFis), such as etanercept and adalimumab, remain the most commonly prescribed biologics for juvenile idiopathic arthritis. 3 However, several other classes of biological DMARDs are now avail able, including the T-cell co-stimulatory modu lator abata cept, the interleukin (IL)-6 pathway inhibitor tocilizumab, IL-1 inhibitors (includ ing the IL-1 receptor antagonist anakinra and IL-1β inhibitor canakinumab), and the targeted B-cell depleting drug rituximab (not licensed for juvenile idio pathic arthritis).…”

Section: Introductionmentioning

confidence: 99%

Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study

Kearsley‐Fleet

Heaf

Davies

et al. 2020

The Lancet Rheumatology

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Background Information is scarce about biological disease-modifying antirheumatic drug (DMARD) switching patterns in children and young people (aged ≤16 years) with juvenile idiopathic arthritis in an era of many biologic therapies. The best choice of biologic to use if the first biological DMARD is not beneficial also remains unclear. We aimed to quantify and characterise biologic switching patterns in children and young people with juvenile idiopathic arthritis, and to compare the effectiveness of using a second tumour necrosis factor inhibitor (TNFi) versus non-TNF is following failure of a first TNFi biologic in routine clinical practice. Methods Our study population comprised patients with juvenile idiopathic arthritis who were enrolled in two parallel UK cohort studies (the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study [BSPAR-ETN] and the Biologics for Children with Rheumatic Diseases [BCRD] study) between Jan 1, 2004, and April 11, 2019. Data on disease characteristics and DMARD therapy were collected at the time of initiation of a first biologic, at 6 months, at 1 year, and annually thereafter. Biologic switching patterns were described in all patients who started their first biologic from Jan 1, 2010, onwards. Among patients who started treatment with their first biologic from Jan 1, 2004, onwards, had polyarticular course juvenile idiopathic arthritis (extended oligoarthritis or polyarthritis [positive or negative for rheumatoid factor]), and who had started a second biologic, we assessed changes in outcome variables at 6 months compared with baseline and compared the proportion of patients who achieved an American College of Rheumatology Pediatric (ACR Pedi) 90 response and minimal disease activity at 6 months on the basis of the class of the second biologic (a second TNFi vs non-TNFi biologic). Changes in outcome variables at 6 months were compared using linear regression or logistic regression, adjusted for propensity quintiles to account for confounding by indication. We used multiple imputation to account for missing data.

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“…2 In the last 10 years, the availability of new potent medications such as biologicals have led to a dramatic improvement in the treatment of JIA. 3 However, it is not fully established which patients are really in need of biologicals or when to start them, generally resulting in less than 20% chance of receiving a biological within 5 years after diagnosis in a recent inception cohort. 4 …”

Section: Introductionmentioning

confidence: 99%

Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis

et al. 2017

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ObjectivesTo assess if the Juvenile Arthritis Disease Activity Score (JADAS71) could be used to correctly identify patients with juvenile idiopathic arthritis (JIA) in need of antitumour necrosis factor therapy (anti-TNF) therapy 3 and 6 months after start of methotrexate (MTX).MethodsMonocentric retrospective cohort study from 2011 to 2015 analysing all patients with oligoarticular JIA (OJIA) (n=39) and polyarticular course JIA (PJIA) (n=74) first starting MTX. Three and 6 months after MTX start, clinical and laboratory features and the 2011 American College of Rheumatology (ACR) JIA treatment recommendations (ACR clinical practice guideline (ACR-CPG)) were compared between groups starting and not starting anti-TNF therapy. The sensitivity and specificity of the ACR-CPG, JADAS71 and the clinical JADAS to identify non-responders after 12 months were calculated.ResultsPhysicians escalated patients with significantly higher physician global assessment, clinical JADAS (cJADAS) and patient Visual Analogue Scale (VAS). The decision not to escalate was correct in 70%–75% as shown by MTX response. The implementation of the ACR-CPG would increase the current anti-TNF use from 12% to 65%. The use of (c)JADAS in identifying patients in need of anti-TNF therapy outperformed the ACR-CPG with a much higher sensitivity, specificity and accuracy. The cJADAS threshold for treatment escalation at month 3 and 6 was >5 and >3 for OJIA and >7 and >4 for PJIA, respectively. The performance of the cJADAS decreased when the patient VAS contribution to the total score was restricted and overall did not improve by adding the erythrocyte sedimentation rate.ConclusionsThe cJADAS identifies patients in need of anti-TNF and is a user-friendly tool ready to be used for treat to target in JIA. The patient VAS is a critical item in the cJADAS for the decision to escalate to anti-TNF.

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Current Medical Treatments for Juvenile Idiopathic Arthritis

Cited by 19 publications

References 64 publications

Implementation of musculoskeletal ultrasonography in detection of early juvenile idiopathic arthritis

Implementation of musculoskeletal ultrasonography in detection of early juvenile idiopathic arthritis

Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study

Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis

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