Factors determining resistance to conventional disease-modifying anti-rheumatic drug treatment in oligoarticular juvenile idiopathic arthritis.
Clin Rheumatol
; 43(6): 2021-2026, 2024 Jun.
Article
in En
| MEDLINE
| ID: mdl-38683443
ABSTRACT
OBJECTIVE:
Our study was designed to investigate the reasons for starting the conventional disease-modifying anti-rheumatic drugs (DMARDs) and the variables that impact the response to DMARD treatment in oligoarticular juvenile idiopathic arthritis (JIA) patients.METHODS:
Oligoarticular JIA patients (n = 187) were categorized into two groups Group A consisted of patients who achieved remission with DMARD, and Group B comprised those who did not respond to DMARD therapy.RESULTS:
DMARDs were initiated for various reasons 68 (36.4%) due to active disease despite nonsteroidal anti-inflammatory drugs (± intra-articular corticosteroid) treatment, 59 (31.6%) due to uveitis, 49 (26.2%) due to extended oligoarticular JIA, and 11 (5.9%) due to inflammatory bowel disease. One hundred twenty-three patients (65.8%) achieved remission with DMARDs (Group A), while 64 patients (34.2%) did not respond to DMARD therapy (Group B). In Group B, patients had higher C-reactive protein (CRP) levels as well as higher Juvenile Idiopathic Arthritis Disease Activity Scores-71 (JADAS-71) at diagnosis (both p < 0.001). Moreover, extended oligoarticular JIA subtype (p = 0.017) and involvement of small joints at diagnosis (p = 0.043) were more prevalent among these patients. Group A exhibited a higher frequency of antinuclear antibody positivity (p = 0.014). Elevated CRP levels (> 1.1 mg/dL) (OR 1.308, 95% CI 1.203-3.574; p < 0.001) and high JADAS-71 at diagnosis (> 15.8) (OR 1.659, 95% CI 1.179-2.941; p < 0.001) were associated with DMARD resistance.CONCLUSION:
Elevated CRP and high JADAS-71 at diagnosis were the main factors associated with DMARD resistance in oligoarticular JIA. Prospective long-term studies may help verify the role of these factors associated with DMARD resistance in oligoarticular JIA. Key Points ⢠Conventional DMARDs were most commonly started due to active disease despite NSAID (± intra-articular corticosteroids). ⢠Remission was achieved with DMARD in 65.8% of oligoarticular JIA patients. ⢠Elevated CRP and high JADAS-71 at diagnosis were associated with DMARD resistance.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Arthritis, Juvenile
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Antirheumatic Agents
Limits:
Adolescent
/
Child
/
Child, preschool
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Female
/
Humans
/
Male
Language:
En
Journal:
Clin Rheumatol
Year:
2024
Document type:
Article
Affiliation country: