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What is low-dose corticosteroid therapy in juvenile idiopathic arthritis? A worldwide, questionnaire-based survey
1FKH, Abteilung für Kinder- und Jugendrheumatologie Im Spitzerfeld 25 69151 Neckargemünd, Germany.
Insights
Pediatric rheumatologists have varied definitions for low-dose, long-term corticosteroid therapy in juvenile idiopathic arthritis (JIA). Further research is needed to establish a standardized definition for this JIA treatment.
Area of Science:
- Pediatric Rheumatology
- Pharmacology
- Clinical Practice Guidelines
Background:
- Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease requiring long-term management.
- Corticosteroids are frequently used in JIA treatment, but definitions of 'low-dose' and 'long-term' vary.
- Establishing a consensus on corticosteroid dosing is crucial for consistent patient care.
Purpose of the Study:
- To investigate pediatric rheumatologists' personal definitions of low-dose, long-term corticosteroid therapy for JIA.
- To identify variations in these definitions across different geographical regions.
- To highlight the need for a standardized definition in JIA management.
Main Methods:
- A standardized questionnaire was distributed to pediatric rheumatologists globally.
- Participants were asked to provide their personal definition of low-dose, long-term corticosteroid therapy for JIA.
- Responses were collected and analyzed from multiple continents, including North America, Europe, the Near East, and Australia.
Main Results:
- Ninety-two evaluable responses were received from 99 questionnaires.
- The average definition of low-dose, long-term corticosteroid therapy was 0.26 +/- 0.14 mg prednisolone/kg body weight/day.
- Significant regional variations in dosage definitions were observed, with Central Europe reporting lower dosages compared to other regions.
Conclusions:
- There is a wide range in pediatric rheumatologists' personal definitions of low-dose, long-term corticosteroid therapy for JIA.
- The reasons for these variations and their clinical impact on patients require further investigation.
- Development and validation of a universally accepted definition for low-dose, long-term corticosteroid therapy in JIA are recommended.
Objective:
To determine pediatric rheumatologists' personal definitions of systemic low-dose, long-term (> 4 weeks) corticosteroid therapy of juvenile idiopathic arthritis (JIA).
Methods:
Pediatric rheumatologists from America, the Near East (Israel), Australia and Europe were asked for their personal definition of a low-dose long-term corticosteroid therapy of JIA with the aid a standardized questionnaire.
Results:
Of 99 questionnaires returned, 92 were evaluable. The dosage still considered low turned out to be 0.26 +/- 0.14 mg prednisolone/kgBW/day (min-max = 0.04-0.50 mg, n = 92). Higher dosages were indicated from Northern Europe (0.29 +/- 0.12, n = 9), Western Europe (0.42 +/- 0.14, n = 7), Southern Europe (0.30 +/- 0.14, n = 9), Eastern Europe (0.25 +/- 0.14, n = 6) and North America (0.33 +/- 0.17, n = 16) than from Central Europe (0.19 +/- 0.09, n = 43).
Conclusion:
Pediatric rheumatologists' personal definitions of low-dose, long-term corticosteroid therapy vary within a wide range. The reason for these differences and the impact on patients should be investigated. In addition, a generally accepted definition for low-dose, long-term corticosteroid therapy should be developed and subsequently examined in studies.