How common is remission in juvenile idiopathic arthritis: A systematic review.

Stephanie J.W Shoop-Worrall,Suzanne M.M Verstappen,Wendy Thomson,Kimme L Hyrich,Lianne Kearsley-Fleet

doi:10.1016/j.semarthrit.2017.05.007

Abstract

ObjectivesThe ideal goal of treatment for juvenile idiopathic arthritis (JIA) is disease remission. However, many sets of remission criteria have been developed and no systematic review of remission in JIA exists.The current systematic review investigated (1) how remission has been defined across JIA clinical cohorts and (2) the frequency of remission overall and within disease categories.MethodsStudies using prospective inception cohorts published after 1972 were selected if they estimated remission in cohorts of ≥50 patients. Articles focusing on specific medical interventions, not defining remission clearly or not reporting disease duration at remission assessment were excluded. Studies were selected from Medline, Embase, PubMed and bibliographies of selected articles. Risks of selection, missing outcome data and outcome reporting biases were assessed.ResultsWithin 17 studies reviewed, 88% had majority female participants and patient disease duration ranged from 0.5 to 17 years. Thirteen sets of criteria for clinically inactive disease and remission were identified. Uptake of Wallace’s preliminary criteria was good in studies recruiting or following patients after their publication (78%).Remission frequencies increased with longer disease duration from 7% within 1.5 years to 47% by 10 years following diagnosis. Patients with persistent oligoarticular and rheumatoid-factor positive polyarticular JIA were most and least likely to achieve remission, respectively.ConclusionsAchievement of remission increased with longer disease duration, but many patients remain in active disease, even in contemporary cohorts. Multiple sets of outcome criteria limited comparability between studies.

Highlights

The aims of this systematic review were to: (i) investigate how remission has been defined across Juvenile idiopathic arthritis (JIA) clinical cohorts and (ii) describe the frequency of remission in cohorts of JIA overall and within individual disease categories
Embase and PubMed databases were searched from January 1972 to March 2015 by author SJWS, using patient intervention comparison outcome (PICO) methodology to build the following strategy: (P) patients with juvenile rheumatoid arthritis (JRA) [13], juvenile chronic arthritis (JCA) [14] or JIA [15], (I) no specified intervention, (C) not applicable and dropped from search design and (O) remission or clinically inactive disease
Disease categories classified under European League against Rheumatism (EULAR) [14] or American College of Rheumatology (ACR) [13] criteria were pooled with corresponding categories in the ILAR criteria [15]

Summary

Introduction

N Corresponding author at: Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, The University of Manchester, 2.800 Stopford Building, Oxford Rd, Manchester M13 9PT, UK. Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood [1]. The presentations, treatments and outcomes are variable across this heterogeneous disease, but the main goal for all patients is disease remission, in order to prevent or reduce the long-term pathologies, such as pain and functional disability [2]. Various sets of remission criteria have been applied across clinical cohorts and in clinical trials, most aim to identify a state of minimal or absent disease activity.

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