The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort Academic Article uri icon

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abstract

  • OBJECTIVE: To describe probabilities and characteristics of disease flares in children with juvenile idiopathic arthritis (JIA) and to identify clinical features associated with an increased risk of flare. METHODS: We studied children in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) prospective inception cohort. A flare was defined as a recurrence of disease manifestations after attaining inactive disease and was called significant if it required intensification of treatment. Probability of first flare was calculated with Kaplan-Meier methods, and associated features were identified using Cox regression. RESULTS: 1146 children were followed up a median of 24 months after attaining inactive disease. We observed 627 first flares (54.7% of patients) with median active joint count of 1, physician global assessment (PGA) of 12 mm and duration of 27 weeks. Within a year after attaining inactive disease, the probability of flare was 42.5% (95% CI 39% to 46%) for any flare and 26.6% (24% to 30%) for a significant flare. Within a year after stopping treatment, it was 31.7% (28% to 36%) and 25.0% (21% to 29%), respectively. A maximum PGA >30 mm, maximum active joint count >4, rheumatoid factor (RF)-positive polyarthritis, antinuclear antibodies (ANA) and receiving disease-modifying antirheumatic drugs (DMARDs) or biological agents before attaining inactive disease were associated with increased risk of flare. Systemic JIA was associated with the lowest risk of flare. CONCLUSIONS: In this real-practice JIA cohort, flares were frequent, usually involved a few swollen joints for an average of 6 months and 60% led to treatment intensification. Children with a severe disease course had an increased risk of flare.

authors

  • Guzman, Jaime
  • Oen, Kiem
  • Huber, Adam M
  • Watanabe Duffy, Karen
  • Boire, Gilles
  • Shiff, Natalie
  • Berard, Roberta A
  • Levy, Deborah M
  • Stringer, Elizabeth
  • Scuccimarri, Rosie
  • Morishita, Kimberly
  • Johnson, Nicole
  • Cabral, David A
  • Rosenberg, Alan M
  • Larche, Margaret
  • Dancey, Paul
  • Petty, Ross E
  • Laxer, Ronald M
  • Silverman, Earl
  • Miettunen, Paivi
  • Chetaille, Anne-Laure
  • Haddad, Elie
  • Houghton, Kristin
  • Spiegel, Lynn
  • Turvey, Stuart E
  • Schmeling, Heinrike
  • Lang, Bianca
  • Ellsworth, Janet
  • Ramsey, Suzanne E
  • Bruns, Alessandra
  • Roth, Johannes
  • Campillo, Sarah
  • Benseler, Susanne
  • Chédeville, Gaëlle
  • Schneider, Rayfel
  • Tse, Shirley ML
  • Bolaria, Roxana
  • Gross, Katherine
  • Feldman, Brian
  • Feldman, Debbie
  • Cameron, Bonnie
  • Jurencak, Roman
  • Dorval, Jean
  • LeBlanc, Claire
  • St. Cyr, Claire
  • Gibbon, Michele
  • Yeung, Rae SM
  • Duffy, Ciarán M
  • Tucker, Lori B

publication date

  • June 2016

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