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Pediatr Rheumatol Online J. 2017 Feb 6;15(1):11. doi: 10.1186/s12969-017-0138-4.

A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months results of the BeSt for Kids-study.

Author information

1
Department of Pediatrics/Pediatric Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. p.hissinkmuller@lumc.nl.
2
Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands. p.hissinkmuller@lumc.nl.
3
Department of Pediatrics/Pediatric Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
4
Department of Pediatrics, Alrijne Hospital Leiderdorp, Leiderdorp, The Netherlands.
5
Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, The Netherlands.
6
Department of Pediatrics, Hagaziekenhuis Juliana Children's Hospital, The Hague, The Netherlands.
7
Department of Pediatric Rheumatology, Amsterdam Rheumatology and Immunology Center location Reade Amsterdam, Amsterdam, The Netherlands.
8
Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
9
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

BACKGROUND:

Combination therapy with prednisone or etanercept may induce earlier and/or more improvement in disease activity in Disease Modifying Anti Rheumatic Drug (DMARD) naïve non-systemic Juvenile Idiopathic Arthritis (JIA) patients. Here we present three months clinical outcome of initial treatments of the BeSt-for-Kids study.

METHODS:

Included patients were randomized to either: 1. initial DMARD-monotherapy (sulfasalazine (SSZ) or methotrexate (MTX)), 2. Initial MTX / prednisolone-bridging, 3. Initial combination MTX/etanercept. Percentage inactive disease, adjusted (a) ACR Pedi30, 50 and 70 and JADAS after 6 and 12 weeks of treatment (intention to treat analysis) and side effects are reported.

RESULTS:

94 patients (67% girls, 32 (arm 1), 32 (arm 2) and 30 (arm 3) with median (InterQuartileRange) age of 9.1 (4.7-12.9) years were included. 38% were ANA positive, 10 had oligo-articular disease, 68 polyarticular JIA and 16 psoriatic arthritis. Baseline median (IQR) ACRpedi-scores: VAS physician 49 (40-58) mm, VAS patient 54 (37-70) mm, ESR 6.5 (2-14.8)mm/hr, active joint count 8 (5-12), limited joint count 3 (1-5), CHAQ score 0.88 (0.63-1.5). In arm 1, 17 started with MTX, 15 with SSZ. After 3 months, aACR Pedi 50 was reached by 10/32 (31%), 12/32(38%) and 16/30 (53%) (p = 0.19) and aACR Pedi 70 was reached by 8/32 (25%), 6/32(19%) and 14/30(47%) in arms 1-3 (p = 0.04). Toxicity was similar. Few serious adverse events were reported.

CONCLUSION:

After 3 months of treatment in a randomized trial, patients with recent-onset JIA achieved significantly more clinical improvement (aACRPedi70) on initial combination therapy with MTX / etanercept than on initial MTX or SSZ monotherapy.

TRIAL REGISTRATION:

NTR1574 . Registered 3 December 2008.

KEYWORDS:

Biologicals; Inactive disease; Juvenile idiopathic arthritis; Treat to target; Treatment strategy study; Window of opportunity

PMID:
28166785
PMCID:
PMC5294738
DOI:
10.1186/s12969-017-0138-4
[Indexed for MEDLINE]
Free PMC Article

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