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Baquet-Walscheid K, Minden K, Niewerth M, Dressler F, Foeldvari I, Foell D, Haas JP, Horneff G, Hospach A, Kallinich T, Kümmerle-Deschner J, Mönkemöller K, Tappeiner C, Windschall D, Klotsche J, Heiligenhaus A. Course of uveitis in children with juvenile idiopathic arthritis (JIA): Five years follow-up data from a prospective multicenter Inception Cohort of Newly diagnosed patients with JIA (ICON-JIA) study. Arthritis Res Ther 2025; 27:61. [PMID: 40114262 PMCID: PMC11924706 DOI: 10.1186/s13075-025-03531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 03/11/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis-associated uveitis (JIAU) typically takes a chronic course, frequently leading to ocular complications and often requiring long-term treatment. The present study assesses the 5-years outcome of JIAU by analyzing data from a prospective study initiated in 2010. METHODS Data from 75 patients with onset of uveitis after study enrollment, and with a documentation at 5-years follow-up (5yFU) were available for analysis of uveitis characteristics, frequency and predictors of "inactivity on medication " (defined as inactive uveitis for ≥ 6 months) and "inactivity off medication " (defined as inactive uveitis for ≥ 6 months off medication). RESULTS At the 5yFU, visual acuity remained good in the majority of eyes (LogMAR < 0.1 in 65.5%; mean LogMAR 0.11 ± 0.31), ocular surgery was required in only 5% of patients, although complications occurred in 46.7% of patients until the 5yFU. Uveitis was inactive in 85.3% of patients, with 77.3% still receiving disease-modifying antirheumatic drugs (DMARDs). Until 5yFU, 82.7% of patients experienced ≥ one episode of "inactivity on medication " (30.7% once, 37.3% twice, 14.7% three or more times), and 17.3% ≥ one episode of "inactivity off medication ", respectively. Both "inactivity on medication " as well as "inactivity off medication " were associated with lower JIA disease activity (cJADAS10; ESR), and with an increased quality of life. CONCLUSIONS Despite intensified DMARD treatment, almost half of the children experience JIAU-related ocular complications after 5 years of disease; however, visual acuity mostly remains good. Uveitis inactivity can be achieved frequently, but is often limited in duration. Lower JIA activity appears to correlate with uveitis inactivity on and off medication.
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Affiliation(s)
- Karoline Baquet-Walscheid
- Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
- University of Duisburg-Essen, Essen, Germany
| | - Kirsten Minden
- Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of, FreieUniversität Berlin and Humboldt- UniversitätZu Berlinaq , Berlin, Germany
| | | | - Frank Dressler
- Department of Pediatrics, Hannover Medical School, Hannover, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Paediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Muenster, Muenster, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Paediatric and Adolescents Medicine, University Hospital Cologne, Cologne, Germany
| | - Anton Hospach
- Centre of Paediatric Rheumatology, Olga Hospital, Stuttgart, Germany
| | - Tilmann Kallinich
- Department of Paediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Jasmin Kümmerle-Deschner
- Autoinflammation Reference Center Tübingen (Arct), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Kirsten Mönkemöller
- Department of Pediatric and Adolescent Medicine, Kliniken Der Stadt Köln gGmbH, Cologne, Germany
| | - Christoph Tappeiner
- University of Duisburg-Essen, Essen, Germany
- Department of Ophthalmology, Pallas Klinik, Olten, Switzerland
- Medical Faculty, University of Bern, Bern, Switzerland
| | - Daniel Windschall
- Pediatric Rheumatology, St. Josef-Stift, Sendenhorst, Germany
- Faculty of Medicine, Martin Luther University of Halle Wittenberg, Halle, Germany
| | - Jens Klotsche
- Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany.
- University of Duisburg-Essen, Essen, Germany.
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Teh KL, Das L, Book YX, Hoh SF, Gao X, Arkachaisri T. Anti-tumor necrosis factor (aTNF) weaning strategy in juvenile idiopathic arthritis (JIA): does duration matter? Clin Rheumatol 2024; 43:1723-1733. [PMID: 38443603 DOI: 10.1007/s10067-024-06928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND To compare outcomes of a short and long weaning strategy of anti-tumor necrosis factor (aTNF) in our prospective juvenile idiopathic arthritis (JIA) cohort. RESEARCH DESIGN AND METHODS JIA patients on subcutaneous adalimumab with at least 6 months of follow-up were recruited (May 2010-Jan 2022). Once clinical remission on medication (CRM) was achieved, adalimumab was weaned according to two protocols-short (every 4-weekly for 6 months and stopped) and long (extending dosing interval by 2 weeks for three cycles until 12-weekly intervals and thereafter stopped) protocols. Outcomes assessed were flare rates, time to flare, and predictors. RESULTS Of 110 JIA patients, 77 (83% male, 78% Chinese; 82% enthesitis-related arthritis) underwent aTNF weaning with 53% on short and 47% on long weaning protocol. The total flare rate during and after stopping aTNF was not different between the two groups. The time to flare after stopping aTNF was not different (p = 0.639). Positive anti-nuclear antibody increased flare risk during weaning in long weaning group (OR 7.0, 95%CI: 1.2-40.8). Positive HLA-B27 (OR 6.5, 95%CI: 1.1-30.4) increased flare risks after stopping aTNF. CONCLUSION Duration of weaning aTNF may not minimize flare rate or delay time to flare after stopping treatment in JIA patients. Recapture rates for inactive disease at 6 months remained high for patients who flared after weaning or discontinuing medication.
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Affiliation(s)
- Kai Liang Teh
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower, Level 3, Zone B, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lena Das
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower, Level 3, Zone B, Singapore, 229899, Singapore
| | - Yun Xin Book
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower, Level 3, Zone B, Singapore, 229899, Singapore
| | - Sook Fun Hoh
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaocong Gao
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower, Level 3, Zone B, Singapore, 229899, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Nieto-González JC, Garulo DC, Boteanu A, Trives-Folguera L, García-Fernández A, Navarro PG, Robledillo JCL, Monteagudo-Saéz I. What to Expect When Systemic Treatment in Juvenile Idiopathic Arthritis Is Withdrawn? J Rheumatol 2023; 50:1326-1332. [PMID: 37527855 DOI: 10.3899/jrheum.2022-1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE The goal of juvenile idiopathic arthritis (JIA) treatment is to maintain clinical remission. It is also important to reduce drug exposure, whenever possible, in order to avoid or decrease potential side effects. We aimed to analyze remission survival after systemic treatment withdrawal and to determine which factors can influence it. METHODS We conducted a multicenter, observational, longitudinal study. All patients included had a diagnosis of JIA. We analyzed remission survival using Kaplan-Meier curves according to the systemic treatment received (methotrexate [MTX] alone or in combination with biologic disease-modifying antirheumatic drugs [bDMARDs]) and JIA subgroups (oligoarticular and polyarticular course, juvenile spondyloarthritis, and systemic JIA). In addition, risk factors were examined using multivariate analysis. RESULTS We included 404 patients with JIA; 370 of them (92%) had received systemic treatment at some point and half of them (185 patients) had withdrawn on at least 1 occasion. There were 110 patients who flared (59%) with a median time of 2.3 years. There were no differences in remission survival between JIA subcategories. Twenty-nine percent of patients with JIA who received MTX and bDMARDs, in which MTX alone was withdrawn, flared; median time to flare of 6.3 years. However, if only the bDMARD was withdrawn, flares occurred 57% of the time; median time to flare of 1.1 years. CONCLUSION Flares are frequent when systemic treatment is withdrawn, and uveitis or joint injections could be related risk factors. In MTX and biologic-naïve patients, the frequency of flares occurred in more than half of patients, although they were less frequent when clinical remission lasted for > 1 year.
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Affiliation(s)
- Juan Carlos Nieto-González
- J.C. Nieto-González, MD, PhD, L. Trives-Folguera, MD, I. Monteagudo-Saéz, MD, PhD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón;
| | - Daniel Clemente Garulo
- D. Clemente Garulo, MD, PhD, J.C. López Robledillo, MD, Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús
| | - Alina Boteanu
- A. Boteanu, MD, A. García-Fernández, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal
| | - Laura Trives-Folguera
- J.C. Nieto-González, MD, PhD, L. Trives-Folguera, MD, I. Monteagudo-Saéz, MD, PhD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón
| | - Antía García-Fernández
- A. Boteanu, MD, A. García-Fernández, MD, Department of Rheumatology, Hospital Universitario Ramón y Cajal
| | - Pablo González Navarro
- P. González Navarro, MSc, Biostatistical Unit, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juan Carlos López Robledillo
- D. Clemente Garulo, MD, PhD, J.C. López Robledillo, MD, Pediatric Rheumatology Unit, Hospital Infantil Universitario Niño Jesús
| | - Indalecio Monteagudo-Saéz
- J.C. Nieto-González, MD, PhD, L. Trives-Folguera, MD, I. Monteagudo-Saéz, MD, PhD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón
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Abstract
PURPOSE OF REVIEW Disease-modifying antirheumatic drugs (DMARDs) have dramatically improved patient outcomes in juvenile idiopathic arthritis (JIA). However, these medications may also result in physical, psychologic, and economic burden, which must be balanced with risk of flare off treatment. Although some children remain in remission after medication discontinuation, evidence is sparse for if, when, and how medications should be de-escalated once achieving clinically inactive disease (CID). We review the data on medication discontinuation and the role of serologic and imaging biomarkers in JIA. RECENT FINDINGS The literature uniformly supports early biologic DMARD initiation, although the optimal timing and strategy for medication withdrawal in patients with sustained CID remains unclear. In this review, we present the current data on flare frequency and time to flare, clinical factors associated with flare, and recapture data for each JIA category. We also summarize the current knowledge on the role of imaging and serologic biomarkers in guiding these treatment decisions. SUMMARY JIA is a heterogenous disease for which prospective clinical trials are needed to address the question of when, how, and in whom to withdraw medication. Research investigating the roles of serologic and imaging biomarkers may help improve the ability to ascertain which children can successfully de-escalate medications.
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Affiliation(s)
- Dori Abel
- Division of Rheumatology, Children’s Hospital of Philadelphia
- PolicyLab, Children’s Hospital of Philadelphia
| | - Pamela F. Weiss
- Division of Rheumatology, Children’s Hospital of Philadelphia
- Clinical Futures, Children’s Hospital of Philadelphia
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
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