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Biologics for JIA strongly associated with rheumatoid factor-positive polyarthritis
Biologic treatment for juvenile idiopathic arthritis, used in 45% of studied cases, was strongly associated with rheumatoid factor-positive polyarthritis, psoriatic arthritis, uveitis and systemic arthritis in a recent study.
Researchers examined data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from May 2010 through May 2011 and identified 2,748 children (median age, 12 years; 73% female) with juvenile idiopathic arthritis (JIA) and median disease duration of 3.9 years. Odds ratios were calculated to estimate associations between clinical patient factors and medication use.
Timothy Beukelman
“The treatment of JIA has changed dramatically over the last 15 years, and current treatment practices have not been well characterized,” researcher Timothy Beukelman, MD, MSCE, associate professor of pediatrics, division of rheumatology, University of Alabama at Birmingham, told Healio.com. “The CARRA Registry provides a unique opportunity to study thousands of children from over 50 pediatric rheumatology centers across the US.”
Among JIA patients, 1,246 (45%) had been treated with biologic disease-modifying antirheumatic drugs (DMARD), while 2,023 (74%) had received nonbiologic DMARD. Biologic DMARD use was strongly associated with rheumatoid factor-positive polyarthritis (OR=4.3; 95% CI, 2.9-6.6), psoriatic arthritis (PsA) (OR=3.0; 95% CI, 2.0-4.4) and uveitis (OR=2.8; 95% CI, 2.1-3.7) among patients without systemic arthritis. Nonbiologic methotrexate was strongly connected with uveitis (OR=5.2; 95% CI, 3.6-7.6), antricitrullinated protein antibodies (OR=4.5; 95% CI, 1.7-12) and extended oligoarthritis (OR=4.1, 95% CI, 2.5-6.6) in patients without systemic arthritis.
One hundred sixty children (65%) with systemic arthritis had received a biologic DMARD, of which tumor necrosis factor inhibitors were associated with polyarthritis (OR=2.5; 95% CI, 3.8-16). Among all patients, 46% had received an intraarticular glucocorticoid injection and 38% received systemic glucocorticoid.
“We found that nonbiologic and biologic DMARD were frequently used in the treatment of JIA and were associated with several specific patient factors,” the researchers concluded.
“The use of biologic agents for the treatment of JIA is very prevalent and is not confined to FDA-approved labeling,” Beukelman said. “Despite frequent use of biologic agents, the use of systemic glucocorticoids for JIA remains common.”
Disclosure: See the study for a full list of relevant disclosures.