Comparing Canadian paediatric rheumatology practice to the 2019 ACR Juvenile Idiopathic Arthritis guidelines: results from the CAPRI Registry
Author:
Park Jonathan1ORCID, Batthish Michelle2ORCID, Berard Roberta A3ORCID, Chédeville Gaëlle4ORCID, Proulx-Gauthier Jean-Philippe5, Rumsey Dax G6, Tucker Lori B1, Wong Stephanie1, Guzman Jaime1ORCID, Cabral David, Chédeville Gaëlle, Duffy Ciarán, Gerhold Kerstin, Guzman Jaime, Hiraki Linda, Huber Adam, Schmeling Heinrike, Shiff Natalie, Tucker Lori, Basodan Daniah, Batthish Michelle, Berard Roberta A, Bolaria Roxana, Bruns Alessandra, Cabral David, Campillo Sarah, Cellucci Tania, Chan Mercedes, Chédeville Gaëlle, Chhabra Amieleena, Dancey Paul, Demirkaya Erkan, Dhalla Muhammed, Duffy Ciaran, Duffy Karen Watanabe, Gerschman Tommy, Guzman Jaime, Heale Liane, Houghton Kristin, Human Andrea, Jurencak Roman, LeBlanc Claire, Lim Lilian, Miettunen Paivi, Morishita Kim, Ng Honyan, Proulx-Gauthier Jean-Philippe, Roth Johannes, Rozenblyum Evelyn, Rumsey Dax G, Schmeling Heinrike, Scuccimarri Rosie, Soon Gordon, Tucker Lori B,
Affiliation:
1. Department of Pediatrics, British Columbia Children’s Hospital and University of British Columbia , Vancouver, British Columbia 2. Department of Pediatrics, McMaster Children’s Hospital, McMaster University , Hamilton 3. Department of Pediatrics, London Health Sciences Centre and Western University , London, Ontario 4. Department of Pediatrics, McGill University Health Centre and McGill University , Montreal 5. Department of Pediatrics, CHU de Québec – Université Laval , Québec City, Québec 6. Department of Pediatrics, Stollery Children’s Hospital, University of Alberta , Edmonton, Alberta, Canada
Abstract
Abstract
Objective
To identify differences between baseline Canadian JIA practices and the 2019 ACR guidelines for JIA.
Methods
Canadian paediatric rheumatologists were surveyed for their opinions on reasonable a priori target adherence rates for JIA guideline recommendations. Prospectively collected data for 266 newly diagnosed children from 2017 to 2019 were analysed to calculate observed adherence rates. Kaplan–Meier survival curves were used to estimate the cumulative incidence of starting synthetic or biologic DMARDs (sDMARD or bDMARD, respectively) for different patient groups.
Results
A total of 25/61 (41%) eligible physicians answered the survey. Most survey respondents (64%) felt that adherence targets should vary depending on the strength of the recommendation and quality of evidence, from a mean of 84% for strong recommendations with high-quality evidence to 29% for conditional recommendations with very low-quality evidence. Data showed 13/19 (68%) recommendations would have met proposed targets and 10/19 (53%) had ≥80% observed adherence. Exceptions were the use of subcutaneous vs oral MTX (53%) and infrequent treatment escalation from NSAIDs to bDMARDs in patients with sacroiliitis (31%) or enthesitis (0%). By 12 weeks, 95% of patients with polyarthritis received sDMARDs, 38% of patients with systemic JIA received bDMARDs and 22% of patients with sacroiliitis received bDMARDs.
Conclusion
Canadian paediatric rheumatology practices were in line with many 2019 JIA guideline recommendations before their publication, except for frequent use of oral MTX and infrequent direct escalation from NSAIDs to bDMARDs in sacroiliitis and enthesitis.
Funder
Arthritis Society, Canada BC Children’s Hospital Research Institute
Publisher
Oxford University Press (OUP)
Subject
Pharmacology (medical),Rheumatology
Reference14 articles.
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