Format

Send to

Choose Destination
Pediatr Rheumatol Online J. 2019 Jul 22;17(1):48. doi: 10.1186/s12969-019-0342-5.

Physician practices for withdrawal of medications in inactive systemic juvenile arthritis, Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey.

Author information

1
Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine & Seattle Children's Hospital and Research Center, MA.7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA. drsshenoi@yahoo.com.
2
Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine & Seattle Children's Hospital and Research Center, MA.7.110, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
3
Division of Rheumatology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
4
Division of Pediatric Rheumatology, University of Utah Hospital, Salt Lake City, UT, USA.
5
Division of Pediatric Rheumatology, Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
6
Parent of systemic juvenile arthritis patient representative, Kansas City, USA.
7
Department of Pediatrics, Rheumatology, Levine Children's Hospital/Carolinas Healthcare System, University, North Carolina, Chapel Hill, NC, USA.
8
Department of Pediatrics, Division of Pulmonary Allergy Immunology and Rheumatology, University of Texas Health Science Center at Houston, Houston, USA.
9
Department of Pediatrics Boston Children's Hospital, Division of Immunology, Boston, MA, USA.
10
Departments of Medicine and Pediatrics, Mayo Clinic College of Medicine, Rochester, MN, USA.
11
Division of Pediatric Rheumatology, Children's National Health System, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
12
The Department of Paediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
13
Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Medical School & University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
14
Division of Pediatric Rheumatology, Hospital for Special Surgery, Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.

Abstract

BACKGROUND:

We describe a Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey of North American pediatric rheumatologists that assesses physician attitudes on withdrawal of medications in systemic juvenile idiopathic arthritis (SJIA).

METHODS:

A REDCap anonymous electronic survey was distributed to 100 random CARRA JIA workgroup physician-voting members. The survey had three broad sections including: A) demographic information; B) physicians' opinions on clinical inactive disease (CID) in SJIA and C) existing practices for withdrawing medications in SJIA.

RESULTS:

The survey had an 86% response rate. 88 and 93% of participants agreed with the current criteria for CID and clinical remission on medications (CRM) respectively. 78% thought it necessary to meet CRM before tapering medications except steroids. 76% use CARRA SJIA consensus treatment plans always or the majority of the time. All participants weaned steroids first in SJIA patients on combination therapy, 47% waited > 6 months before tapering additional medications. 35% each tapered methotrexate over > 6 months and 2-6 months; however, 39% preferred tapering anakinra, canakinumab and tocilizumab more quickly over 2-6 months and favored spacing the dosing interval for canakinumab and tocilizumab. When patients are on combination therapy with methotrexate and biologics, 58% preferred tapering methotrexate first while others considered patient/family preference and adverse effects to guide their choice.

CONCLUSION:

Most CARRA members surveyed use published consensus treatment plans for SJIA and agree with validated definitions of CID and CRM. There was agreement with tapering steroids first in SJIA. There was considerable variability with tapering decisions of all other medications.

KEYWORDS:

CARRA; Inactive disease; Systemic Juvenile Idiopathic Arthritis; Withdrawal of medications

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center