Arthritis Research & Therapy (Sep 2023)

Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes

  • Filipa Oliveira Ramos,
  • Ana Maria Rodrigues,
  • Ana Teresa Melo,
  • Francisca Aguiar,
  • Luísa Brites,
  • Soraia Azevedo,
  • Ana Catarina Duarte,
  • José António Melo Gomes,
  • Carolina Furtado,
  • Ana Filipa Mourão,
  • Graça Sequeira,
  • Inês Cunha,
  • Ricardo Figueira,
  • Maria José Santos,
  • João Eurico Fonseca

DOI
https://doi.org/10.1186/s13075-023-03166-9
Journal volume & issue
Vol. 25, no. 1
pp. 1 – 9

Abstract

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Abstract Background Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact of the time between JIA onset and the initiation of a bDMARD in achieving clinical remission, on physical disability and health-related quality of life (HRQoL). Methods Adult JIA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) and ever treated with bDMARD were included. Data regarding socio-demographic, JIA-related characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), and treatments were collected at the last visit. Patients were divided into 3 groups (≤ 2 years, 2–5 years, or > 5 years), according to the time from disease onset to bDMARD initiation. Regression models were obtained considering remission on/off medication, HAQ-DI, SF-36, and joint surgeries as outcomes and time from disease onset to bDMARD start as an independent variable. Results Three hundred sixty-one adult JIA patients were evaluated, with a median disease duration of 20.3 years (IQR 12.1; 30.2). 40.4% had active disease, 35.1% were in remission on medication, and 24.4% were in drug-free remission; 71% reported some degree of physical disability. Starting a bDMARD > 5 years after disease onset decreased the chance of achieving remission off medication (OR 0.24; 95% CI 0.06, 0.92; p = 0.038). Patients who started a bDMARD after 5 years of disease onset had a higher HAQ and worse scores in the physical component, vitality, and social function domains of SF-36, and more joint surgeries when compared to an earlier start. Conclusion Later initiation of bDMARDs in JIA is associated with a greater physical disability, worse HRQoL, and lower chance of drug-free remission in adulthood.

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