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[Protocols in pediatric rheumatology (PROKIND): treat-to-target in polyarticular juvenile idiopathic arthritis]
G Horneff1,2, K Minden3,4, D Foell5
1Zentrum für Allgemeine Pädiatrie und Neonatologie, Asklepios Klinik Sankt Augustin, 53757, Sankt Augustin, Deutschland. g.horneff@asklepios.com.
Insights
The PROKIND protocols significantly improved diagnostics and treatment for polyarticular juvenile idiopathic arthritis (JIA). A treat-to-target approach led to dramatic improvements in disease activity and functional capacity within 12 months.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Clinical Trials
Context:
- Polyarticular juvenile idiopathic arthritis (JIA) presents diagnostic and treatment challenges.
- The PROKIND protocols aim to standardize JIA management.
- Harmonizing diagnostics, monitoring, and treatment decisions is crucial for prognosis.
Purpose:
- To evaluate the effectiveness of a treat-to-target strategy in polyarticular JIA.
- To assess disease activity, functional limitation, and quality of life in JIA patients.
- To report outcomes of a prospective, observational study during the first year of treatment.
Summary:
- A prospective study followed 129 polyarticular JIA patients using a treat-to-target approach.
- Disease activity (JADAS-10) decreased from 16.4 to 2.8; functional capacity (CHAQ-DI) improved from 1.0 to 0.3.
- Remission was achieved in 66.7% by 12 months, with biologics needed for 38-60% based on treatment cohort.
Impact:
- The treat-to-target approach dramatically improved disease activity and quality of life in polyarticular JIA.
- Achieving inactive disease in the majority of patients within 12 months demonstrates treatment efficacy.
- This study provides evidence for optimized JIA management strategies.
Background:
The aims of the PROKIND protocols are improvement and harmonization of the diagnostics, monitoring, treatment decision and prognosis.
Material And Methods:
This article reports the results of a prospective treat-to-target observational study of patients with polyarticular juvenile idiopathic arthritis (JIA) during the first year of treatment. Disease activity was assessed with the 10-joint juvenile arthritis disease activity score (JADAS-10), functional limitation with the childhood health assessment questionnaire disability index (CHAQ-DI) and with information on overall well-being, on pain, on fatigue and on global estimation of disease activity.
Results:
Overall, 129 patients with polyarticular JIA (rheumatoid factor, RF, positive (+) polyarthritis n = 22, RF negative (-) polyarthritis n = 133 from 23 pediatric rheumatology institutions in Germany and Austria were recruited. Patients with initial treatment with methotrexate formed cohort 1, patients with additional repeated intravenous corticosteroid pulse therapy formed cohort 2 and patients with concomitant intra-articular corticosteroid administration in at least 5 joints formed cohort 3. The mean JADAS10 showed a decrease in disease activity from 16.4 ± 6.1 to 2.8 ± 3.6 and the decrease in the CHAQ-DI from 1.0 ± 0.8 to 0.3 ± 0.5 showed the improvement in functional capacity. Similarly, improvements in quality of life, pain and fatigue were demonstrable. A JADAS inactive disease was achieved by 18.1% at month 3, 47.7% at month 6 and 66.7% at month 12. In cohort 1 a JADAS remission was achieved by 72.4%, by 50% in cohort 2 and by 69.2% in cohort 3. An escalation to treatment with biologics was necessary in 38% of patients in cohort 1, 60% in cohort 2 and 46% in cohort 3.
Conclusion:
Using a treat-to-target approach a dramatic improvement in disease activity, functional capacity and quality of life in polyarticular JIA could be achieved. Even after 12 months an inactive disease was achieved in the majority of cases.
