The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort.
OBJECTIVE
To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments.


METHODS
Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan-Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments.


RESULTS
In a cohort of 1104 children, the probabilities of attaining an active joint count of 0 exceeded 78% within 2 years in all JIA categories. The probability of attaining inactive disease exceeded 70% within 2 years in all categories, except for RF-positive polyarthritis (48%). The probability of discontinuing treatment at least once was 67% within 5 years. The probability of attaining remission within 5 years was 46-57% across JIA categories except for polyarthritis (0% RF-positive, 14% RF-negative). Initial treatment included joint injections and non-steroidal anti-inflammatory drugs for oligoarthritis, disease-modifying antirheumatic drugs (DMARDs) for polyarthritis and systemic corticosteroids for systemic JIA.


CONCLUSIONS
Most children with JIA managed with contemporary treatments attain inactive disease within 2 years of diagnosis and many are able to discontinue treatment. The probability of attaining remission within 5 years of diagnosis is about 50%, except for children with polyarthritis.
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
Jaime
J
Guzman
Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Canada.
Kiem
K
Oen
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
Lori B
LB
Tucker
IWK Health Centre and Dalhousie University, Halifax, Canada.
Adam M
AM
Huber
Royal University Hospital and University of Saskatchewan, Saskatoon, Canada.
Natalie
N
Shiff
Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada.
Gilles
G
Boire
McGill University Health Centre and McGill University, Montreal, Canada.
Rosie
R
Scuccimarri
London Health Sciences Centre and Western University, London, Canada.
Roberta
R
Berard
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Shirley M L
SM
Tse
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
Kimberly
K
Morishita
IWK Health Centre and Dalhousie University, Halifax, Canada.
Elizabeth
E
Stringer
The Alberta Children's Hospital and University of Calgary, Calgary, Canada.
Nicole
N
Johnson
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Deborah M
DM
Levy
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada.
Karen Watanabe
KW
Duffy
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
David A
DA
Cabral
Royal University Hospital and University of Saskatchewan, Saskatoon, Canada.
Alan M
AM
Rosenberg
McMaster University, Hamilton, Canada.
Maggie
M
Larché
Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Canada.
Paul
P
Dancey
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
Ross E
RE
Petty
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Ronald M
RM
Laxer
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Earl
E
Silverman
The Alberta Children's Hospital and University of Calgary, Calgary, Canada.
Paivi
P
Miettunen
Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada.
Anne-Laure
AL
Chetaille
CHU Ste. Justine and Université de Montréal, Montréal, Canada.
Elie
E
Haddad
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
Kristin
K
Houghton
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Lynn
L
Spiegel
British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada.
Stuart E
SE
Turvey
The Alberta Children's Hospital and University of Calgary, Calgary, Canada.
Heinrike
H
Schmeling
IWK Health Centre and Dalhousie University, Halifax, Canada.
Bianca
B
Lang
The Stollery Children's Hospital and University of Alberta, Edmonton, Canada.
Janet
J
Ellsworth
IWK Health Centre and Dalhousie University, Halifax, Canada.
Suzanne
S
Ramsey
Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada.
Alessandra
A
Bruns
McGill University Health Centre and McGill University, Montreal, Canada.
Sarah
S
Campillo
The Alberta Children's Hospital and University of Calgary, Calgary, Canada.
Susanne
S
Benseler
McGill University Health Centre and McGill University, Montreal, Canada.
Gaëlle
G
Chédeville
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Rayfel
R
Schneider
Hospital for Sick Children and University of Toronto, Toronto, Canada.
Rae
R
Yeung
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada.
Ciarán M
CM
Duffy
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D001688:Biological Products; D005938:Glucocorticoids
Epidemiology; Juvenile Idiopathic Arthritis; Outcomes research; Treatment