New Study Seeks to Protect Against Medication Failure in JIA

Alysha Taxter, MD

With treatment failure being a major impediment to care for patients with juvenile idiopathic arthritis (JIA), investigators are hoping to better identify the disease early to prevent medication failure.

A team, led by Alysha Taxter, MD, Nationwide Children's Hospital, assessed whether baseline patient-reported outcomes are linked to changes in JIA pharmacotherapy treatment and whether symptom duration prior to diagnosis is associated with disease activity scores over time.

The Diagnostic Challenge

Pediatric patients with JIA often show symptoms several months to years prior to an official diagnosis from a pediatric rheumatologist. However, untreated disease can lead to a number of negative outcomes, including chronic pain, muscle atrophy, joint contractures, limb-length discrepancies, and abnormal growth.

“It is suggested that there is a critical window of opportunity to diagnose and treat this disease, and early treatment may limit unfavorable outcomes,” the authors wrote.

Another issue in this patient population is that treatments are only effective 50-60% of the time and patients will have to wait several months to see whether or not the treatment will work for them.

There has been research that suggests patients with higher pain and higher patient-reported and provider-reported global assessment scores at diagnosis suffered from worse long-term outcomes.

The Study

In the retrospective cohort study, the investigators examined patients at Wake Forest Baptist Health between 2015-2019 with an incident diagnosis of juvenile idiopathic arthritis and collected patient-reported symptom duration, pain, energy, disease activity, sleep, anxiety, and depression screenings, as well as provider-reported disease activity and joint count during routine clinical care.

Each participant was seen at a tertiary academic medical center outpatient pediatric rheumatology clinic.

The team used a Cox proportional hazard to evaluated patient-reported outcomes, disease activity scores, and symptom duration with initial medication failure within 9 months of diagnosis and used multivariate mixed effects linear regression to evaluate the association of symptom duration with disease activity scores.

The study included 58 pediatric patients, 35% of which had oligoarticular JIA. Almost half of the patients in the study failed initial therapy within 9 months. The unadjusted analysis showed higher energy (HR, 0.82; 95% CI, 0.69-0.99; P = 0.04) and longer symptom duration (HR, 0.96; 95% CI, 0.93-0.99; P = 0.03) at diagnosis were protective factors against medication failure.

Associations

The adjusted analysis showed symptom duration prior to diagnosis was protective against medication failure (HR, 0.95; 95% CI, 0.92-0.99; P = 0.02). However, the investigators did not find an association between medication failure and pain, psychiatric symptoms, or disease activity scores.

In addition, there was a positive association with longer symptom duration and higher disease activity at 30 and 60 days. However, this was not sustained.

“Higher energy levels and longer symptom duration are protective against initial JIA treatment failures,” the authors wrote. “Initial treatments informed by patient-reported data could lead to more successful outcomes by changes in treatment paradigms.”

The study, “Association Between Patient-Reported Outcomes and Treatment Failure in Juvenile Idiopathic Arthritis,” was published online in ACR Open Rheumatology.