Real life treatment in juvenile idiopathic arthritis: Is remission long lasting?

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that can cause pediatric disability. Achieving stable remission is the main objective to avoid disability. We evaluated remission survival in a cohort of patients with JIA and analyzed factors that might influence long lasting remission.

We designed an observational, retrospective and longitudinal study of JIA patients. Remission survival was determined from the first visit in clinical remission to the first flare after remission or the last visit recorded at the end of the study. Stable remission was defined as patients fulfilling the Wallace criteria during 18 months of the Covid pandemic. To compare the role of treatment on stable remission, we divided patients into three groups: without systemic treatment, treated with methotrexate only and treated with biologics.

We included 82 JIA patients, 68.3% of whom were female and the median age of disease onset was 4.49 years old. There were no differences in the remission survival rates between JIA subgroups. Nearly 80% had maintained remission at 3 years and a high proportion of patients (68.3%) were still in remission after 5 years. Fifty-seven patients (69.5%) reached stable remission throughout 18 months of the Covid-19 pandemic. Stable remission was more likely in patients without systemic treatment (47.4%) (p=0.015).

Remission survival was long-term in real life conditions, with nearly 80% of our patients maintaining stable remission after 3 years. Flares were more frequent in patients treated with methotrexate in monotherapy.