There has been a progressive decline in the levels of disease activity and disability among children with juvenile idiopathic arthritis over the past 25 years, according to research presented this week at the American College of Rheumatology Annual Meeting in San Diego. This research confirms the notion that recent advances in the management of the disease have led to a substantial improvement in health outcomes for children living with it.
There are several types of juvenile idiopathic arthritis, (commonly called JIA or juvenile rheumatoid arthritis) all involving chronic (long-term) joint inflammation. This inflammation begins before patients reach the age of 16, may involve one or many joints, and can cause other symptoms such as fevers, rash and/or eye inflammation. Systemic onset JIA is a subset of JIA that affects about 10 percent of children with arthritis. It begins with recurrent fevers that can be 103° F or higher, often accompanied by a pink rash that comes and goes. Systemic onset JIA may cause inflammation of the internal organs as well as the joints, though joint swelling may not appear until months or even years after the symptoms begin.
Over the last three decades there have been important advances in the management of JIA, which include the introduction of methotrexate as a potential early treatment, the widespread use of intra- articular corticosteroid injections, and -- more recently -- the availability of biologic response modifiers (commonly called biologics). Although this treatment progress has led to a marked improvement in the outlook of children with JIA, the impact of these newer treatments is still poorly documented.
Researchers from the University of Geneva in Geneva, Italy recently reviewed the medical records of 1,079 children who were treated for JIA between January 1987 and March 2012 to determine if there were any noticeable changes in disease activity and physical disability over this period of time.
Throughout the study period, physician -- and parent/patient-centered outcomes were systematically assessed. The researchers leveraged this long term data collection to investigate how changes in treatment over that time period impacted these outcomes.
Measures of disease activity included the physician's and parent's global ratings, the parent's pain rating, and the count of joints with swelling, tenderness or pain.
Measures of disability included the number of joints with limited range of motion and a questionnaire that assessed the ability of the child to perform the physical functional activities and the activities of daily living (the Childhood Health Assessment Questionnaire, CHAQ before March 2007 and the Juvenile Arthritis Functionality Scale, JAFS after that date). To enable comparison of functional ability evaluations, both CHAQ and JAFS scores were converted to a 0-10 scale (0=best; 10=worst). Parent's global and pain ratings as well as functional ability assessment were not available for visits made prior to 1995 because prior to 1195, these assessments were made on scales not comparable
Dr. Ravelli's team reviewed medical records from 6,502 visits in four different time periods: 1) 1987 to 1996; 2) 1996-2000; 3) 2001-2005; and 4) 2006-2012. In all areas reviewed, the researchers noted marked improvements over each successive time period.
"The observation of a progressive decline in the levels of disease activity and physical disability in children with JIA means that pediatric rheumatologists may be more optimistic to children and their parents about disease prognosis and may also reassure them that the child is much less likely to develop damage to joints and impairment in physical function," explains Angelo Ravelli, MD; associate professor of pediatrics; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova; and lead investigator in the study. "The next step is to compare this data with that obtained in the next two to five years, when the impact of the newer biologic medications (namely Tocilizumab (Actemra®), canakinumab (Ilaris®) and rilonacept (Arcalyst®)) will be noted particularly in the care of systemic JIA, which is one of the most severe forms of JIA. In the perspective of an improvement of clinical research methodology, this study demonstrates the importance of regular quantitative assessment of disease state through the use of standardized clinical measures to document in a reliable manner the impact of emerging therapeutic strategies on disease prognosis."
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