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Paediatric Rheumatology

 

Analysis of arthritis flares after achievement of inactive disease with methotrexate monotherapy in juvenile idiopathic arthritis


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18

 

  1. Università degli Studi di Genova, Italy. ceciliabava4@gmail.com
  2. Università degli Studi di Genova, Italy.
  3. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  4. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  5. Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
  6. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  7. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  8. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy.
  9. IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
  10. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  11. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  12. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  13. Ospedale Regina Montis Regalis, Mondovì, Italy.
  14. Università degli Studi di Genova, Italy, and Royal Manchester Children’s Hospital, Manchester, UK.
  15. IRCCS Istituto Giannina Gaslini, Genova, Italy.
  16. Università degli Studi di Genova, Italy.
  17. Università degli Studi di Genova and IRCCS Istituto Giannina Gaslini, Genova, Italy.
  18. Università degli Studi di Genova, IRCCS Istituto Giannina Gaslini, Genova, Italy, and Sechenov First Moscow State Medical University, Moscow, Russian Federation.

CER13449
2021 Vol.39, N°2
PI 0426, PF 0433
Paediatric Rheumatology

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PMID: 33200734 [PubMed]

Received: 14/04/2020
Accepted : 21/09/2020
In Press: 12/11/2020
Published: 09/04/2021

Abstract

OBJECTIVES:
To investigate the frequency of arthritis flare and factors affecting occurrence of flare in children with juvenile idiopathic arthritis (JIA) who achieved inactive disease (ID) with methotrexate (MTX) monotherapy.
METHODS:
A total of 217 patients were included. The modality of treatment discontinuation, time of MTX withdrawal, and disease course were examined retrospectively. For each patient, the first episode of ID after MTX start was evaluated. Patient follow-up was censored at occurrence of flare or at last visit with persistent ID.
RESULTS:
170 patients (78.3%) had arthritis flare after a median of 1.6 years, whereas 47 (21.7%) maintained ID until last visit, after a median of 3 years. 54.2% of patients had discontinued MTX after ID, whereas 45.8% were still receiving MTX at the time of study censoring. Among patients who had MTX withdrawn, the median interval between ID and MTX stop was 1.5 years. Occurrence of flare was more common in patients who were still receiving MTX at study censoring than in those who had discontinued MTX (p<0.001). Most patients (78.8%) had MTX tapered over time by increasing the interval between doses. Tapering modality was comparable between patients with flare and persistent ID. Only 7.7% of the patients had a biologic DMARD started at the time of flare.
CONCLUSIONS:
Our results confirm that children with JIA who achieve ID with MTX monotherapy have a high risk of arthritis flare. The risk of flare was independent of withdrawal strategy. Most flare episodes were not treated with biologic therapy.

Rheumatology Article