Disease activity and damage in juvenile idiopathic arthritis: methotrexate era versus biologic era

Gabriella Giancane,Valentina Muratore,Valentina Marzetti,Francesca Bagnasco,Angelo Ravelli,Lorenzo Quartulli,Belen Serrano Benavente,Neus Quilis,Alessandro Consolaro,Alessandra Alongi,Adele Civino

doi:10.1186/s13075-019-1950-7

Abstract

ObjectiveTo compare the long-term disease state, in terms of activity and damage, of children with juvenile idiopathic arthritis (JIA) who had their disease onset in methotrexate (MTX) or biologic eras.MethodsPatients were included in MTX or biologic era cohort depending on whether their disease presentation occurred before or after January 2000. All patients had disease duration ≥ 5 years and underwent a prospective cross-sectional assessment, which included measurement of disease activity and damage. Inactive disease (ID) and low disease activity (LDA) states were defined according to Wallace, JADAS10, and cJADAS10 criteria. Articular and extraarticular damage was assessed with the Juvenile Arthritis Damage Index (JADI).ResultsMTX and biologic era cohorts included 239 and 269 patients, respectively. Patients were divided in the “functional phenotypes” of oligoarthritis and polyarthritis. At cross-sectional visit, patients in the biologic era cohort with either oligoarthritis or polyarthritis had consistently higher frequencies of ID and LDA by all criteria. The measurement of disease damage at cross-sectional visit revealed that the frequency of impairment of > 1 JADI-Articular items was higher in MTX than in biologic era cohort (17.6% versus 11% in oligoarthritis and 52.6% versus 21.8% in polyarthritis). Likewise, frequency of involvement of > 1 JADI-Extraarticular items was higher in the MTX than in the biologic era cohort (26.5% versus 16.2% in oligoarthritis and 31.4% versus 13.5% in polyarthritis).ConclusionOur study provides evidence of the remarkable outcome improvement obtained with the recent therapeutic advance in JIA.

Highlights

Over the past three decades, the management of juvenile idiopathic arthritis (JIA) has evolved considerably
The therapeutic advance in this disease has been marked by two major breakthroughs: the first was represented by the introduction of methotrexate (MTX) in the mid of the 1980s; the second, which took place in the 2000s, was brought by the marketing of biologic
Patients were classified as having oligoarthritis or polyarthritis if they had involvement of 4 or less joints or 5 or more joints, respectively, in the whole disease course, irrespective of their individual International League of Associations for Rheumatology (ILAR) category

Summary

Introduction

Over the past three decades, the management of juvenile idiopathic arthritis (JIA) has evolved considerably. The efficacy of MTX in JIA was initially suggested by Truckenbrodt and co-workers in 1986 [3] and was established in a US-former USSR collaborative randomized controlled trial (RCT) published in 1992 [4]. The widespread use of MTX was paralleled by the growing popularity of intraarticular corticosteroid therapy [6]. This therapeutic procedure was initially used only for the knees, but was applied to other joints and performed repeatedly [7, 8]. Several outcome studies published in the early 2000s documented improved outlook for children with JIA in the MTX era as compared to previous decades [9,10,11]

Methods

Results

Conclusion