title: Treatment prescribing patterns in patients with juvenile idiopathic arthritis (JIA): Analysis from the UK Childhood Arthritis Prospective Study (CAPS).
abstract: Initial treatment of juvenile idiopathic arthritis (JIA) is largely based on the extent of joint involvement, disease severity and ILAR category. The licensing of biologic therapies for JIA has expanded treatment options. The aims of the study are (1) to describe treatment prescribing patterns in JIA over the first 3 years following first presentation to paediatric rheumatology and (2) to determine whether patterns of treatment have changed as biologics have become more widely available.
  
  
  
  Children with at least 3 years of follow-up within the Childhood Arthritis Prospective Study (CAPS) were included. For analysis, children were placed into one of five groups according to their initial presentation to paediatric rheumatology: oligoarthritis (oJIA), polyarthritis (pJIA), systemic (sJIA), enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). Treatment patterns over 3 years were described.
  
  
  
  Of 1051 children, 58% received synthetic disease-modifying anti-rheumatic drugs (sDMARD) and 20% received biologics over the 3 years. Use of sDMARDs and biologics was higher in more severe disease presentations (sJIA and pJIA); however, 35% and 10% who presented with oJIA were also treated with sDMARDs and biologics, respectively. The number of children receiving sDMARD after 2006 was higher (p = 0.02); however, there was no difference in biologic prescribing before and after 2006 (p = 0.4).
  
  
  
  A high proportion of children presenting with JIA received sDMARDs plus/minus biologics during 3 years of follow-up. This was most common for patients with severe JIA but was also prescribed for patients with oligoarticular disease, despite the lack of evidence for effectiveness in this category.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Davies
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Carrasco
authors.affiliation: Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University and Paediatric Rheumatology, Great North Children׳s Hospital, Newcastle upon Tyne, UK.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Foster
authors.affiliation: Department of Paediatric Rheumatology, Alder Hey Children׳s Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Baildam
authors.affiliation: Department of Rheumatology, Royal Manchester Children׳s Hospital, Manchester, UK.
authors.forename: S E Alice
authors.initials: SEA
authors.lastname: Chieng
authors.affiliation: Department of Paediatric Rheumatology, Royal Hospital for Children, Glasgow, UK.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Davidson
authors.affiliation: Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK.
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Ioannou
authors.affiliation: Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK; Infection, Inflammation, and Rheumatology Section, Institute of Child Health, UCL and Great Ormond Street Hospital NHS Trust, UCL Institute of Child Health, London, UK.
authors.forename: Lucy R
authors.initials: LR
authors.lastname: Wedderburn
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University, Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Thomson
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University, Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK. Electronic address: kimme.hyrich@manchester.ac.uk.
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
mesh_terms: D000293:Adolescent; 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; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Biologic therapy; DMARD therapy; Juvenile idiopathic arthritis; Treatment