No radiographic wrist damage after treatment to target in recent-onset juvenile idiopathic arthritis

P C E Hissink Muller,M Maas,D M C Brinkman,J M Van Den Berg,R Ten Cate,T W Kuijpers,R Hemke,S A Bergstra,M A J Van Rossum,C M Nusman,Y Koopman-Keemink,D Schreurs,L W A Van Suijlekom-Smit,W G Van Braak,D Schonenberg-Meinema,C F Allaart

doi:10.1186/s12969-019-0362-1

Abstract

BackgroundTo evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target.MethodsPatients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration.ResultsIn 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from − 0,82; 0.68), nor for BA (varying from − 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (− 1.48; − 0.68) compared to arm 1 (− 0.84; − 0.04) and arm 2 (− 0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1).ConclusionsRecent-onset JIA patients, treated-to-target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment.Trial registrationNTR, NL1504 (NTR1574). Registered 01-06-2009.

Highlights

To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target
Despite a symptom duration of mean (SD) 7.6 (4.9) months and a Juvenile Arthritis Disease Activity Score (JADAS)-10 of 18.7 (5.6), at baseline, we found no significant differences in Poznanski-score and Bone Age (BA) of wrist radiographs compared to healthy children
We conclude that in our cohort of patients with recentonset JIA who were treated-to-target aiming at inactive disease, wrist-radiographs showed neither damage according to Poznanski at baseline, nor progression after 2 years

Summary

Introduction

To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target. We have recently performed a randomized clinical trial using the treatment-to-target approach in recent-onset JIA patients, comparing 3 strategy-arms with different initial and subsequent treatment steps, aiming at inactive disease, including tapering and stopping DMARD therapy [10, 11]. In this population we studied radiographic wrist damage using the Poznanski-score, at baseline and evaluated whether damage occurred or recovered with the abrogation of inflammation in the 3 strategy-arms. In addition we used the BoneXpert-method to determine the Bone Age (BA) and Bone Mineral Density (BMD) as markers for joint damage [12]

Methods

Results

Discussion

Conclusion