Abstract
Chronic arthritis is estimated to affect approximately 300,000 children in the US, although estimates vary widely. Juvenile idiopathic arthritis (JIA), diagnosed in children under age 16, can manifest as morning stiffness, joint pain & tenderness, fever, rash and uveitis. The course of JIA subtypes is variable, with some patients achieving remission and some converting to a persistent course into adulthood. A cohort of JIA patients was identified in the OM1 Data Cloud (OM1, Boston), an ongoing, continually enrolling, representative sample of over 240 million patients in the US. Clinical (EMR) data and linked administrative claims data from January 2013 - May 2019 were utilized. Cohort included patients <20 years who met criteria of at least two JIA related outpatient diagnosis codes within a 1 year period, one JIA-related inpatient encounter or ≥2 diagnosis codes by a rheumatologist. A total of 30,238 patients with a mean age of 11.6±4.9 years were identified. The majority of patients were female (70.0%) and predominantly white (88.8%). Most patients were characterized as polyarticular (69.2%) and 9.7% of patients were documented as systemic onset of JIA. Uveitis was documented in 3678 patients (12.1%). Approximately 17% of patients were treated with at least one biologic disease-modifying therapy (bDMARD), including tumor necrosis factor alpha inhibitors (TNFa, 12.8%), IL-6 inhibitors (3.1%) and JAK inhibitors (0.3%) and 11% with conventional (c)DMARDs. Treatment with bDMARDs was more common in older patients (age <6 10.8%; age 6-11 15.0%; age ≥12 19.9%). A slightly higher proportion of female patients were treated with bDMARDs (17.5% versus 16.3% male) or cDMARDs (11.8% vs. 10.4% male). Most common cDMARD utilized was methotrexate (6.9%). The increasing use of bDMARDs in JIA may have long term ramifications for JIA patients with sustained disease related to steroid-sparing and cardiovascular risk associated with systemic inflammation.
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