title: Outcome and Trends in Treatment of Systemic Juvenile Idiopathic Arthritis in the German National Pediatric Rheumatologic Database, 2000-2013.
abstract: To investigate the clinical presentation and medical treatment of patients with systemic juvenile idiopathic arthritis (JIA) during the first year of illness. Our study focused on 3-year outcomes in a subsample of patients who were followed up longitudinally.
  
  
  
  From 2000 to 2013, 597 patients with systemic JIA and a disease duration of ≤12 months were recorded in the National Pediatric Rheumatologic Database. Among those patients, 3-year outcome data were available for 133. These data included the clinical Juvenile Arthritis Disease Activity Score in 10 joints (JADAS-10) and the physician's global assessment score (on a numerical rating scale), as well as assessment of joint involvement, growth retardation, and patient-reported outcomes.
  
  
  
  The median clinical JADAS-10 declined significantly, from 7 in 2000 to 2 in 2013, while the proportion of patients with inactive disease increased from 19% in 2000 to 41% in 2013. The rate of treatment with systemic glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) remained stable from 2000 to 2013. By 2013, the proportion of patients with systemic JIA who were treated with biologic DMARDs had increased to 20%. At 3-year follow-up, 72% of patients with systemic JIA had inactive disease, and 77% had no functional limitations. Growth retardation was associated with persistently high disease activity and continuing treatment with systemic glucocorticoids. At the 3-year follow-up, one-third of patients were still being treated with systemic glucocorticoids.
  
  
  
  The proportion of patients with inactive disease has increased over the past decade. Possible explanations may include improved access to specialized care, additional treatment options, and earlier or faster step-up treatment. However, challenges in the management of systemic JIA remain, as ∼30% of patients continue to present with ongoing active disease.
authors.affiliation: German Rheumatism Research Centre Berlin and Charité University Hospital Berlin, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.affiliation: German Rheumatism Research Centre Berlin and Charité University Hospital Berlin, Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Raab
authors.affiliation: German Rheumatism Research Centre Berlin, Berlin, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Niewerth
authors.affiliation: German Rheumatism Research Centre Berlin, Berlin, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sengler
authors.affiliation: St. Josef-Stift Sendenhorst Hospital, Sendenhorst, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Ganser
authors.affiliation: Charité University Hospital Berlin, Berlin, Germany.
authors.forename: Tilmann
authors.initials: T
authors.lastname: Kallinich
authors.affiliation: HELIOS Klinikum Krefeld, Krefeld, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Niehues
authors.affiliation: University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hufnagel
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Thon
authors.affiliation: Olgahospital, Clinical Center Stuttgart, Stuttgart, Germany.
authors.forename: Toni
authors.initials: T
authors.lastname: Hospach
authors.affiliation: Asklepios Clinic Sankt Augustin, St. Augustin, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Horneff
authors.affiliation: German Rheumatism Research Centre Berlin and Charité University Hospital Berlin, Berlin, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Minden
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany; D005938:Glucocorticoids / Q000627:therapeutic use*; D006130:Growth Disorders / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D000071066:Patient Reported Outcome Measures; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids