Question: Which is the best strategy to achieve (drug-free) inactive disease in juvenile idiopathic arthritis (JIA)?
Methods: In a randomised, single-blinded, study in disease-modifying anti-rheumatic drug (DMARD)-naive patients with JIA, three treatment-strategies were compared: (1) sequential DMARD-monotherapy (sulfasalazine or methotrexate (MTX)), (2) combination therapy MTX + 6 weeks prednisolone and (3) combination therapy MTX +etanercept. Treatment-to-target entailed 3-monthly DMARD/biological adjustments in case of persistent disease activity, with drug tapering to nil in case of inactive disease.After 24 months, primary outcomes were time-to-inactive-disease and time-to-flare after DMARD discontinuation. Secondary outcomes were adapted ACRPedi30/50/70/90 scores, functional ability and adverse events.
Results: 94 children (67 % girls) aged median (IQR) 9.1 (4.6-12.9) years were enrolled: 32 in arms 1 and 2, 30 in arm 3. At baseline visual analogue scale (VAS) physician was mean 49 (SD 16) mm, VAS patient 53 (22) mm, erythrocyte sedimentation rate 12.8 (14.7), active joints median 8 (5-12), limited joints 2.5 (1-4.8) and Childhood Health Assessment Questionnaire score mean 1.0 (0.6).After 24 months, 71% (arm 1), 70% (arm 2) and 72% (arm 3) of patients had inactive disease and 45% (arm 1), 31% (arm 2) and 41% (arm 3) had drug-free inactive disease. Time-to-inactive-disease was median 9.0 (5.3-15.0) months in arm 1, 9.0 (6.0-12.8) months in arm 2 and 9.0 (6.0-12.0) months in arm 3 (p=0.30). Time-to-flare was not significantly different (overall 3.0 (3.0-6.8) months, p=0.7). Adapted ACR pedi-scores were comparably high between arms. Adverse events were similar.
Conclusion: Regardless of initial specific treatments, after 24 months of treatment-to-target aimed at drug-free inactive disease, 71% of recent-onset patients with JIA had inactive disease (median onset 9 months) and 39% were drug free. Tightly controlled treatment-to-target is feasible.
Trial Registration Number: 1574.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1136/annrheumdis-2018-213902 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Investigating context-specific sedentary behaviours and cardiometabolic health in college-based young adults (CONTEXT-SB): a protocol for a longitudinal observational study.
BMJ Open
December 2024
Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Background: Sedentary behaviour (SB) is detrimental to cardiometabolic disease (CMD) risk, which can begin in young adulthood. To devise effective SB-CMD interventions in young adults, it is important to understand which context-specific SB (CS-SB) are most detrimental for CMD risk, the lifestyle behaviours that cluster with CS-SBs and the socioecological predictors of CS-SB.
Methods And Analysis: This longitudinal observational study will recruit 500 college-aged (18-24 years) individuals.
Thymidine phosphorylase participates in platelet activation and promotes inflammation in rheumatoid arthritis.
Toxicol Appl Pharmacol
December 2024
Department of Rheumatology and Clinical Immunology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China. Electronic address:
The elevated risk of cardiovascular disease (CVD) associated with inflammatory rheumatic diseases has long been recognized. Patients with established rheumatoid arthritis (RA) have a higher mortality rate compared to the general population due to abnormal platelet activation. Thymidine phosphorylase (TYMP) plays a crucial role in platelet activation and thrombosis, following bridging the link between RA and CVD.
View Article and Find Full Text PDFPurpose: This study evaluates the efficacy of intravitreal injections (IVI) of faricimab in patients with neovascular age-related macular degeneration (nAMD) and retinal pigment epithelium detachment (RPED) resistant to other anti-VEGF agents.
Material And Methods: The study included 61 patients (61 eyes) with nAMD previously treated with aflibercept and/or brolucizumab IVIs. Three groups were formed: group 1 received aflibercept IVI (32 eyes), group 2 received brolucizumab IVI (14 eyes), and group 3 received aflibercept followed by brolucizumab IVI (15 eyes).
Purpose: This study investigates the capabilities of ultrasonography (US) in determing the stage of orbital inflammation in patients with granulomatosis with polyangiitis (GPA).
Material And Methods: The study included 24 patients (8 men and 16 women) with diffuse orbital tissue involvement in GPA. Group 1 (active stage) included nine patients, while group 2 (inactive stage) consisted of 18 patients.
Escalation of intravenous fentanyl self-administration and assessment of withdrawal behavior in male and female mice.
Psychopharmacology (Berl)
December 2024
Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, 47904, USA.
Rationale: The rise in overdose deaths from synthetic opioids, especially fentanyl, necessitates the development of preclinical models to study fentanyl use disorder (FUD). While there has been progress with rodent models, additional translationally relevant models are needed to examine excessive fentanyl intake and withdrawal signs.
Objective: The current study aimed to develop a translationally relevant preclinical mouse model of FUD by employing chronic intravenous fentanyl self-administration (IVSA).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!