Predicting disease outcomes in juvenile idiopathic arthritis: challenges, evidence, and new directions

Shoop-Worrall, Stephanie; Wu, Qiong; Davies, Rebecca; Hyrich, Kimme L; Wedderburn, Lucy R.

doi:10.1016/s2352-4642(19)30188-9

Cited by 24 publications

(19 citation statements)

References 89 publications

(65 reference statements)

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“…Using standardized and validated outcome tools and measurements is inconsistent among JIA studies. Various clinical and laboratory variables have been suggested as predictors for disease damage and quality of life of patients with JIA 6,23,24 . Data about the disease activity status and disease damage of JIA are increasingly reported worldwide.…”

Section: Discussionmentioning

confidence: 99%

“…The consanguineous marriage in Arab countries reaches 50%‐75% of all marriages, which might underscore the overall prevalence of autoimmune diseases and the influencing role of genetic factors in the disease phenotype and outcome 5 . Predicting JIA outcome is challenging; most of the studies related the long‐term outcomes to various predictors, including JIA category, diagnostic delay and late initiation of the appropriate treatment 6,7 . Also, other factors such as biomarkers could add value to the clinical variables 8 .…”

Section: Introductionmentioning

confidence: 99%

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Familial aggregation of juvenile idiopathic arthritis with other autoimmune diseases: Impact on clinical characteristics, disease activity status and disease damage

et al. 2021

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Objectives To evaluate the impact of family history of autoimmune diseases (FHADs) on the clinical characteristics and outcome of juvenile idiopathic arthritis (JIA). Methods We retrospectively reviewed children with JIA seen in 7 pediatric rheumatology clinics from 6 Arab countries. All included patients met the International League of Associations for Rheumatology classification criteria for JIA and had a disease duration greater than 1 year. Data were collected at the last follow‐up visit and comprised clinical findings, including FHADs. Disease activity and disease damage were assessed by Juvenile Arthritis Multidimensional Assessment Report, and juvenile arthritis damage index (JADI) respectively. Disease activity was categorized as remission off treatment, remission on treatment, or active disease. Results A total of 349 (224 females) JIA patients with a disease duration of 5 (interquartile range 2.9‐7.5) years were included. The most frequent JIA categories were polyarticular JIA and oligoarticular JIA, followed by systemic JIA. There were 189 patients with FHADs and 160 patients without FHADs. The most frequent FHADs were diabetes mellitus (21.2%), JIA (18.5%), rheumatoid arthritis (12.7%). Among patients with FHADs, 140/189 (74.1%) achieved clinical remission, while 131/160 (81.9%) patients without FHDs had clinical remission (odds ratio [OR] = 1.2, 95% CI 0.97‐1.5). Rate of consanguinity, enthesitis‐related arthritis (ERA) and psoriatic arthritis were higher in patients with FHADs (OR = 0.6, 95% CI 0.4‐0.9 and OR = 1.2, 95% CI 1.1‐1.4). Also, articular JADI correlated significantly with presence of FHADs (OR = 1.1, 95% CI 1.0‐1.1). Conclusion This study shows that autoimmune diseases cluster within families of patients with JIA with a high proportion of ERA and psoriatic arthritis. JIA patients with FHADs are likely to have more disease damage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Familial aggregation of juvenile idiopathic arthritis with other autoimmune diseases: Impact on clinical characteristics, disease activity status and disease damage

et al. 2021

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“…There have been previous reviews exploring the broad subject of biomarker identification in JIA (Consolaro et al, 2015;Gohar et al, 2016;Shoop-Worrall et al, 2019). This review exposed a diverse group of potential biomarkers, including inherent patient characteristics, clinical, laboratory, genetic, transcriptomic and imaging features, which are associated with short-term and long-term therapeutic goals, such as the attainment of inactive disease on biologic treatment and the sustainment of clinical remission after treatment withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis

et al. 2021

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Background: Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis of childhood, characterized by various clinical phenotypes associated with variable prognosis. Significant progress has been achieved with the use of biologic treatments, which specifically block pro-inflammatory molecules involved in the disease pathogenesis. The most commonly used biologics in JIA are monoclonal antibodies and recombinant proteins targeting interleukins 1 (IL-1) and 6 (IL-6), and tumor necrosis factor α (TNF-α). Several biomarkers have been investigated in JIA.Aims: To assess the level of evidence available regarding the role of biomarkers in JIA related to guiding clinical and therapeutic decisions, providing disease prognostic information, facilitating disease activity monitoring and assessing biologic treatment response in JIA, as well as propose new strategies for biologic therapy-related biomarker use in JIA.Methods: We searched PubMed for relevant literature using predefined key words corresponding to several categories of biomarkers to assess their role in predicting and assessing biologic treatment response and clinical remission in JIA.Results: We reviewed serological, cellular, genetic, transcriptomic and imaging biomarkers, to identify candidates that are both well-established and widely used, as well as newly investigated in JIA on biologic therapy. We evaluated their role in management of JIA as well as identified the unmet needs for new biomarker discovery and better clinical applications.Conclusion: Although there are no ideal biomarkers in JIA, we identified serological biomarkers with potential clinical utility. We propose strategies of combining biomarkers of response to biologics in JIA, as well as routine implementation of clinically acceptable imaging biomarkers for improved disease assessment performance.

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“…Considering the heterogeneity of JIA, it was unexpected that costs were higher in patients with polyarticular JIA when the incidence of hospitalizations, complications and mortality are describe as higher in systemic JIA, and there are reports of more disability rates in enthesitis-related JIA [37]. This may be associated to lower remission rates in rheumatoid factor positive-polyarticular JIA, increasing the time of therapy, or due to the more frequent use of biologics to treat it [38][39][40], however, we were unable to carry out a more in-depth analysis in this subject.…”

Section: Discussionmentioning

confidence: 99%

Economic impact of Juvenile Idiopathic Arthritis: a systematic review

et al. 2021

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Background Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies. Methods We comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made. Results We found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found. Conclusion The costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.

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Predicting disease outcomes in juvenile idiopathic arthritis: challenges, evidence, and new directions

Cited by 24 publications

References 89 publications

Familial aggregation of juvenile idiopathic arthritis with other autoimmune diseases: Impact on clinical characteristics, disease activity status and disease damage

Familial aggregation of juvenile idiopathic arthritis with other autoimmune diseases: Impact on clinical characteristics, disease activity status and disease damage

Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis

Economic impact of Juvenile Idiopathic Arthritis: a systematic review

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