The magnitude of early response to methotrexate therapy predicts long-term outcome of patients with juvenile idiopathic arthritis

Abstract

Our results show that the achievement of an ACR Pediatric 70 response at 6 months after start of MTX therapy predicts a more favorable long-term outcome of patients with JIA.

Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort

“…A recent study also demonstrated that an ACR Pedi 70 criteria response to methotrexate after 6 months of therapy was associated with improved outcomes, including lower AJC and inactive disease after 5 years, compared with those with lower responses or nonresponders (17). The authors concluded that the early disease course and response to treatment may be stronger predictors of long-term outcome than disease characteristics at onset (17). In patients with systemic JIA, the need for corticosteroids at 6 months after diagnosis is also a predictor of poor functional outcome (33).…”

“…However, to put our results in perspective, in 2 recent clinical trials, 44% and 33% of patients with a severe polyarticular disease course who had failed treatment with methotrexate achieved an ACR Pedi 70 criteria response after 7 and 12 months, respectively, with etanercept, and in another trial, 52% reached this response after 1 year of infliximab treatment (21,22,28). The ACR Pedi 70 criteria response rate 6 months after starting methotrexate was 26% in a study of patients with polyarthritis, systemic arthritis, and extended oligoarthritis (17). In our study, 55% of patients with RF-negative polyarthritis achieved an ACR Pedi 70 criteria response, suggesting a good shortterm outcome.…”

“…Moreover, the variety of outcome measures and definitions of remission used in past studies makes comparisons difficult, and the majority of studies have been retrospective with inherent disadvantages such as incomplete patient retrieval and data. Finally, most of the previous studies have assessed long-term outcomes, whereas a current concept in therapy is that early disease control and improvement lead to better ultimate disease outcome (17). However, our present knowledge is limited by the paucity of information about both disease control and improvement early in disease as well as long-term outcomes achieved with current treatment strategies.…”

Aggressive Combination Drug Therapy in Very Early Polyarticular Juvenile Idiopathic Arthritis (ACUTE-JIA): a multicentre randomised open-label clinical trial

“…In polyarticular disease, arthritis often remains active for longer periods than it does in persistent oligoarthritis,1 3 4 and patients may thus have disease of greater severity and higher risk prolonged 1 3–6. In recent studies, an early response to methotrexate at 6 months predicted better long-term outcome,7 and achieving inactive disease at least once within 5 years from onset also predicted less joint damage 8. Efforts to establish early effective therapies for polyarticular JIA should therefore be strengthened.…”

Association of the 5-aminoimidazole-4-carboxamide ribonucleotide transformylase gene with response to methotrexate in juvenile idiopathic arthritis

“…As expected, there was a higher prevalence of women in both cohorts. Disease duration has been recently reported as linked with MTX response14: the median time of disease duration prior to starting MTX in these two cohorts was around 1 year.…”