Investigators from the University of British Columbia, Vancouver, Canada, and McMaster University, Hamilton, Canada, conducted a retrospective cohort study to assess long-term outcomes in children diagnosed with juvenile idiopathic arthritis (JIA) during the era when biologic treatments were available. Study participants had been enrolled in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) study that was designed to assess clinical outcomes in patients diagnosed with JIA between 2005 and 2010. Medical records of children in this cohort were reviewed in 2018, and data on disease activity, current treatment, and joint damage at their last visit were abstracted. Disease activity was classified as active or inactive based on the Wallace criteria; participants were classified as being in remission off medications if they had ≥12 continuous months with inactive disease while being off medications and in remission on medication if they had ≥6 continuous months with inactive disease while receiving medications.1 The rate of inactive disease among the patients in the study was informally compared to that of a historical cohort of children diagnosed with JIA between 1974 and 1994 at 1 of 3 Canadian centers. In this cohort, 41% had active disease at a median age of 18.8 years.2
Data were analyzed on 247 participants. The median age at last visit for these patients was 16.9 years with a median length of follow-up of 5.6 years after diagnosis; 58% were female. Overall, 180 study patients (73%; 95% CI, 67%–78%) met criteria for inactive disease; 61 (25%; 95% CI, 20%–30%) were in remission on medications, and 116 (47%; 95% CI, 41%–53%) were in remission off medications. Among different types of JIA, those with systemic JIA had the highest remission rate (70%), and those with rheumatoid factor-positive polyarthritis had the lowest (18%). For patients with active disease, 22% had no active joints at the last visit, and 43% had one active joint. Overall, joint damage (erosion or joint space narrowing on x-ray or MRI) was seen in 45 participants (18%), 2 had avascular necrosis, and 5 (2%) required joint surgery. At their last visit 51% of study participants were on at least one antirheumatic medication, including 10% on nonsteroidal anti-inflammatory drugs, 19% on disease-modifying antirheumatic drugs, and 22% on biologics.
The authors conclude that, in the era of biologic therapy, children with JIA have a more favorable prognosis compared to historical cohorts.
Dr Higgins has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
In the original multicenter ReACCh-Out cohort, composed of 1,104 Canadian JIA patients followed from 2005–2010, 48% of patients with rheumatoid factor-positive polyarthritis and ≥70% of patients with other types of JIA achieved inactive disease...