title: Treatment of patients with juvenile idiopathic arthritis (JIA) in a population-based cohort.
abstract: A population-based cohort was utilized to evaluate medications and intra-articular injection utilization for patients with juvenile idiopathic arthritis (JIA) to inform clinical practice and further research. In a geographically defined population, all incident cases of JIA cases were identified between January 1, 1994 and December 31, 2013 based first on diagnosis code followed by medical chart confirmation. Medications and intra-articular glucocorticoid injections were abstracted. Predictors of the first disease-modifying antirheumatic drug (DMARD)/biologic and injections were reported as a hazard ratio (HR) with 95 % confidence intervals (CIs) adjusted for age and sex. Kaplan-Meier methods evaluated therapy at 6 months and 1 year. Injections were reported per 100 person-years (py) with 95 % CI using the Poisson methods. Seventy-one incident cases were identified. Forty-two (59 %) were female with mean age (standard deviation) at diagnosis of 8.2 (5.3) years. Twenty-six (37 %) utilized at least one DMARD or biologic, in which 77 % of these were prescribed in the first 6 months. Subtype of JIA was significantly associated with DMARDs/biologics (p < 0.001). Intra-articular injections were performed in 48 %. The rate of intra-articular injections was 20.7 per 100 py (95 % CI 16.5, 25.6). The rate of joint injections was higher in the first year after diagnosis (p < 0.001) and more common in recent years (p < 0.001). The majority of patients with JIA in a modern population-based cohort do not require DMARDs or biologics. In those who do, the majority receives these within the first 6 months. Intra-articular injections were utilized in almost half of patients with JIA and were increasingly used.
authors.affiliation: Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA. Zamora-Legoff.Jorge@mayo.edu.|Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Zamora-Legoff.Jorge@mayo.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Zamora-Legoff
authors.affiliation: Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Krause
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Theresa Wampler
authors.initials: TW
authors.lastname: Muskardin
authors.affiliation: Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mason
authors.affiliation: Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.|Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D053208:Kaplan-Meier Estimate; D008297:Male; D008910:Minnesota; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D001688:Biological Products; D005938:Glucocorticoids
keywords: Biologics; DMARD; Intra-articular Injections; Juvenile idiopathic arthritis; NSAIDS
references.citation: J Rheumatol. 2002 Jul;29(7):1520-30
references.pmid: 12136914
references.citation: J Rheumatol. 2004 Feb;31(2):390-2
references.pmid: 14760812
references.citation: Rheumatology (Oxford). 2011 Jan;50(1):6-15
references.pmid: 20627969
references.citation: Arthritis Care Res (Hoboken). 2011 Apr;63(4):465-82
references.pmid: 21452260
references.citation: Arthritis Rheum. 2011 Sep;63(9):2809-18
references.pmid: 21560116
references.citation: Arthritis Rheum. 2012 Apr;64(4):1263-71
references.pmid: 22328538
references.citation: J Rheumatol. 2012 Sep;39(9):1867-74
references.pmid: 22859354
references.citation: Clin Exp Rheumatol. 2012 Nov-Dec;30(6):972-8
references.pmid: 23190600
references.citation: Rheumatology (Oxford). 2013 Oct;52(10):1905-13
references.pmid: 23873820
references.citation: Clin Exp Rheumatol. 2014 Mar-Apr;32(2):291-6
references.pmid: 24238066
references.citation: Ann Rheum Dis. 2015 Jul;74(7):1379-86
references.pmid: 24641940
references.citation: Ann Rheum Dis. 2015 Oct;74(10):1854-60
references.pmid: 24842571
references.citation: Rheumatology (Oxford). 2015 Jul;54(7):1170-6
references.pmid: 25504896
references.citation: Ann Rheum Dis. 2015 Nov;74(11):1946-57
references.pmid: 26245755
references.citation: Arthritis Rheumatol. 2016 Jan;68(1):247-54
references.pmid: 26316119