Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry
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Published:2022-11-25
Issue:1
Volume:20
Page:
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ISSN:1546-0096
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Container-title:Pediatric Rheumatology
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language:en
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Short-container-title:Pediatr Rheumatol
Author:
Hahn TimothyORCID, Daymont Carrie, Beukelman Timothy, Groh Brandt, Hays Kimberly, Bingham Catherine April, Scalzi Lisabeth, Abel N., Abulaban K., Adams A., Adams M., Agbayani R., Aiello J., Akoghlanian S., Alejandro C., Allenspach E., Alperin R., Alpizar M., Amarilyo G., Ambler W., Anderson E., Ardoin S., Armendariz S., Baker E., Balboni I., Balevic S., Ballenger L., Ballinger S., Balmuri N., Barbar-Smiley F., Barillas-Arias L., Basiaga M., Baszis K., Becker M., Bell-Brunson H., Beltz E., Benham H., Benseler S., Bernal W., Beukelman T., Bigley T., Binstadt B., Black C., Blakley M., Bohnsack J., Boland J., Boneparth A., Bowman S., Bracaglia C., Brooks E., Brothers M., Brown A., Brunner H., Buckley M., Buckley M., Bukulmez H., Bullock D., Cameron B., Canna S., Cannon L., Carper P., Cartwright V., Cassidy E., Cerracchio L., Chalom E., Chang J., Chang-Hoftman A., Chauhan V., Chira P., Chinn T., Chundru K., Clairman H., Co D., Confair A., Conlon H., Connor R., Cooper A., Cooper J., Cooper S., Correll C., Corvalan R., Costanzo D., Cron R., Curiel-Duran L., Curington T., Curry M., Dalrymple A., Davis A., Davis C., Davis C., Davis T., De Benedetti F., De Ranieri D., Dean J., Dedeoglu F., DeGuzman M., Delnay N., Dempsey V., DeSantis E., Dickson T., Dingle J., Donaldson B., Dorsey E., Dover S., Dowling J., Drew J., Driest K., Du Q., Duarte K., Durkee D., Duverger E., Dvergsten J., Eberhard A., Eckert M., Ede K., Edelheit B., Edens C., Edens C., Edgerly Y., Elder M., Ervin B., Fadrhonc S., Failing C., Fair D., Falcon M., Favier L., Federici S., Feldman B., Fennell J., Ferguson I., Ferguson P., Ferreira B., Ferrucho R., Fields K., Finkel T., Fitzgerald M., Fleming C., Flynn O., Fogel L., Fox E., Fox M., Franco L., Freeman M., Fritz K., Froese S., Fuhlbrigge R., Fuller J., George N., Gerhold K., Gerstbacher D., Gilbert M., Gillispie-Taylor M., Giverc E., Godiwala C., Goh I., Goheer H., Goldsmith D., Gotschlich E., Gotte A., Gottlieb B., Gracia C., Graham T., Grevich S., Griffin T., Griswold J., Grom A., Guevara M., Guittar P., Guzman M., Hager M., Hahn T., Halyabar O., Hammelev E., Hance M., Hanson A., Harel L., Haro S., Harris J., Harry O., Hartigan E., Hausmann J., Hay A., Hayward K., Heiart J., Hekl K., Henderson L., Henrickson M., Hersh A., Hickey K., Hill P., Hillyer S., Hiraki L., Hiskey M., Hobday P., Hoffart C., Holland M., Hollander M., Hong S., Horwitz M., Hsu J., Huber A., Huggins J., Hui-Yuen J., Hung C., Huntington J., Huttenlocher A., Ibarra M., Imundo L., Inman C., Insalaco A., Jackson A., Jackson S., James K., Janow G., Jaquith J., Jared S., Johnson N., Jones J., Jones J., Jones J., Jones K., Jones S., Joshi S., Jung L., Justice C., Justiniano A., Karan N., Kaufman K., Kemp A., Kessler E., Khalsa U., Kienzle B., Kim S., Kimura Y., Kingsbury D., Kitcharoensakkul M., Klausmeier T., Klein K., Klein-Gitelman M., Kompelien B., Kosikowski A., Kovalick L., Kracker J., Kramer S., Kremer C., Lai J., Lam J., Lang B., Lapidus S., Lapin B., Lasky A., Latham D., Lawson E., Laxer R., Lee P., Lee P., Lee T., Lentini L., Lerman M., Levy D., Li S., Lieberman S., Lim L., Lin C., Ling N., Lingis M., Lo M., Lovell D., Lowman D., Luca N., Lvovich S., Madison C., Madison J., Manzoni S. Magni, Malla B., Maller J., Malloy M., Mannion M., Manos C., Marques L., Martyniuk A., Mason T., Mathus S., McAllister L., McCarthy K., McConnell K., McCormick E., McCurdy D., Stokes P. Mc Curdy, McGuire S., McHale I., McMonagle A., McMullen-Jackson C., Meidan E., Mellins E., Mendoza E., Mercado R., Merritt A., Michalowski L., Miettunen P., Miller M., Milojevic D., Mirizio E., Misajon E., Mitchell M., Modica R., Mohan S., Moore K., Moorthy L., Morgan S., Dewitt E. Morgan, Moss C., Moussa T., Mruk V., Murphy A., Muscal E., Nadler R., Nahal B., Nanda K., Nasah N., Nassi L., Nativ S., Natter M., Neely J., Nelson B., Newhall L., Ng L., Nicholas J., Nicolai R., Nigrovic P., Nocton J., Nolan B., Oberle E., Obispo B., O’Brien B., O’Brien T., Okeke O., Oliver M., Olson J., O’Neil K., Onel K., Orandi A., Orlando M., Osei-Onomah S., Oz R., Pagano E., Paller A., Pan N., Panupattanapong S., Pardeo M., Paredes J., Parsons A., Patel J., Pentakota K., Pepmueller P., Pfeiffer T., Phillippi K., Marafon D. Pires, Phillippi K., Ponder L., Pooni R., Prahalad S., Pratt S., Protopapas S., Puplava B., Quach J., Quinlan-Waters M., Rabinovich C., Radhakrishna S., Rafko J., Raisian J., Rakestraw A., Ramirez C., Ramsay E., Ramsey S., Randell R., Reed A., Reed A., Reed A., Reid H., Remmel K., Repp A., Reyes A., Richmond A., Riebschleger M., Ringold S., Riordan M., Riskalla M., Ritter M., Rivas-Chacon R., Robinson A., Rodela E., Rodriquez M., Rojas K., Ronis T., Rosenkranz M., Rosolowski B., Rothermel H., Rothman D., Roth-Wojcicki E., Rouster-Stevens K., Rubinstein T., Ruth N., Saad N., Sabbagh S., Sacco E., Sadun R., Sandborg C., Sanni A., Santiago L., Sarkissian A., Savani S., Scalzi L., Schanberg L., Scharnhorst S., Schikler K., Schlefman A., Schmeling H., Schmidt K., Schmitt E., Schneider R., Schollaert-Fitch K., Schulert G., Seay T., Seper C., Shalen J., Sheets R., Shelly A., Shenoi S., Shergill K., Shirley J., Shishov M., Shivers C., Silverman E., Singer N., Sivaraman V., Sletten J., Smith A., Smith C., Smith J., Smith J., Smitherman E., Soep J., Son M., Spence S., Spiegel L., Spitznagle J., Sran R., Srinivasalu H., Stapp H., Steigerwald K., Rakovchik Y. Sterba, Stern S., Stevens A., Stevens B., Stevenson R., Stewart K., Stingl C., Stokes J., Stoll M., Stringer E., Sule S., Sumner J., Sundel R., Sutter M., Syed R., Syverson G., Szymanski A., Taber S., Tal R., Tambralli A., Taneja A., Tanner T., Tapani S., Tarshish G., Tarvin S., Tate L., Taxter A., Taylor J., Terry M., Tesher M., Thatayatikom A., Thomas B., Tiffany K., Ting T., Tipp A., Toib D., Torok K., Toruner C., Tory H., Toth M., Tse S., Tubwell V., Twilt M., Uriguen S., Valcarcel T., Van Mater H., Vannoy L., Varghese C., Vasquez N., Vazzana K., Vehe R., Veiga K., Velez J., Verbsky J., Vilar G., Volpe N., von Scheven E., Vora S., Wagner J., Wagner-Weiner L., Wahezi D., Waite H., Walker J., Walters H., Muskardin T. Wampler, Waqar L., Waterfield M., Watson M., Watts A., Weiser P., Weiss J., Weiss P., Wershba E., White A., Williams C., Wise A., Woo J., Woolnough L., Wright T., Wu E., Yalcindag A., Yee M., Yen E., Yeung R., Yomogida K., Yu Q., Zapata R., Zartoshti A., Zeft A., Zeft R., Zhang Y., Zhao Y., Zhu A., Zic C.,
Abstract
Abstract
Background
Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.
Methods
We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.
Results
We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).
Conclusion
While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
Publisher
Springer Science and Business Media LLC
Subject
Immunology and Allergy,Rheumatology,Pediatrics, Perinatology and Child Health
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