Active Disease at 3 Months Predicts Poorer Long-Term Outcomes in JIA

Erin Balay-Dustrude, MD, MS

Credit: University of Washington

Findings from a single-center retrospective study revealed patients with active juvenile idiopathic arthritis (JIA) at 12 and 24 months were more likely to be older at diagnosis and were psoriatic, have enthesitis-related JIA, or were polyarticular rheumatoid factor (RF)-negative, according to research published in ACR Open Rheumatology.¹ Results also showed active disease at month 3 post diagnosis was linked to worse long-term outcomes.

“Identification of characteristics associated with active disease in JIA could inform early disease treatment strategies,” wrote a team of investigators led by Erin Balay-Dustrude, MD, MS, assistant professor at the University of Washington and rheumatology fellow at Seattle Children's Hospital and Research Center.¹

Previous research has been published regarding poor prognostic factors for JIA disease outcomes prior to the introduction of biologic disease-modifying antirheumatic drugs (bDMARDs) in 1999, which included longer disease duration before treatment initiation, early hip, wrist, or ankle involvement, and elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at baseline and throughout the course of treatment. However, the availability of bDMARDs has significantly improved outcomes among this patient population.^2,3 Therefore, investigators sought to determine the characteristics linked to active non-systemic categories of JIA in the post-bDMARD treatment landscape.

To do so, investigators collected patient data from Seattle Children's Hospital between 2004 and 2018. These data were analyzed at months 3, 12, and 24. The relative prevalence (RP) of disease activity was assessed in connection to prespecified characteristics. The effect of increasing biologic disease-modifying antirheumatic drug (bDMARD) availability on these predictors was determined at month 12 using RP.¹

In total, 1151 patients with JIA were included in the analysis. Older children (aged >5 years) exhibited a 40% to 45% higher point prevalence of active disease at month 12 when compared with younger patients. Those with active disease at month 3 were more likely to have greater disease prevalence at both 12 months (RP 1.5, 95% confidence interval [CI] 1.2 – 1.8) and 24 months (RP 1.3, 95% CI 1 – 1.6).¹

Similarly, patients who were psoriatic, had enthesitis-related JIA, and were polyarticular RF-negative had a greater prevalence of active disease at both 12 and 24 months when compared with oligoarticular JIA. At the 24-month mark, patients aged ≥ 10 years were more likely to have greater disease activity.¹

The RP of active disease was 25% lower between 2013 and 2018 when compared with the earliest cohort (2004–2008; RP .75, 95% CI .62 – .92). This coincided with the increased availability of biologic medication options. However, the predictors of disease activity were comparable across time periods.¹

Investigators mentioned the retrospective nature of the study design as a limitation. Additionally, assessing disease activity at months 3, 12, and 24 did not account for flares and movement between disease states. A sensitivity analysis mitigated this potential hinderance. Lastly, treatment patterns for JIA categories have changed over the years, including the addition of new US Food and Drug Administration-approved options. The time period analysis helped to lessen the impact these changes may have had on the findings.¹

“These observations align with findings from earlier studies,” investigators concluded.¹ “Nonetheless, further work is needed to identify stronger predictors of active disease as novel therapeutic agents become available.”

References

1. ^{Balay-Dustrude E, Weiss NS, Sutton A, Shenoi S. Predictors of Disease Activity in Patients With Juvenile Idiopathic Arthritis at 12 and 24 Months After Diagnosis. ACR Open Rheumatol. Published online June 17, 2024. doi:10.1002/acr2.11701}
2. ^{Rypdal V, Arnstad ED, Aalto K, et al; Nordic Study Group of Pediatric Rheumatology (NoSPeR). Predicting unfavorable long-term outcome in juvenile idiopathic arthritis: results from the Nordic cohort study. Arthritis Res Ther 2018; 20(1): 91.}
3. ^{Flatø B, Lien G, Smerdel A, et al. Prognostic factors in juvenile rheumatoid arthritis: a case-control study revealing early predictors and outcome after 14.9 years. J Rheumatol 2003; 30(2): 386–393.}