Protocols in pediatric rheumatology (PROKIND) : treat-to-target in polyarticular juvenile idiopathic arthritis
© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:83 |
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| Enthalten in: |
Zeitschrift fur Rheumatologie - 83(2024), 1 vom: 29. Feb., Seite 15-27 |
| Sprache: |
Deutsch |
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| Weiterer Titel: |
Protokolle in der Kinderrheumatologie (PROKIND): Treat-to-Target bei polyartikulärer juveniler idiopathischer Arthritis |
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| Beteiligte Personen: |
Horneff, G [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 07.02.2024 Date Revised 07.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00393-023-01452-0 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 246 | 3 | 3 | |a Protokolle in der Kinderrheumatologie (PROKIND): Treat-to-Target bei polyartikulärer juveniler idiopathischer Arthritis |
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| 520 | |a © 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature. | ||
| 520 | |a BACKGROUND: The aims of the PROKIND protocols are improvement and harmonization of the diagnostics, monitoring, treatment decision and prognosis | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a English Abstract | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Biologics | |
| 650 | 4 | |a Disease activity | |
| 650 | 4 | |a Juvenile arthritis disease activity score | |
| 650 | 4 | |a Quality of life | |
| 650 | 4 | |a Remission | |
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| 700 | 1 | |a Klotsche, J |e verfasserin |4 aut | |
| 700 | 1 | |a Tenbrock, K |e verfasserin |4 aut | |
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