TY - JOUR
T1 - No radiographic wrist damage after treatment to target in recent-onset juvenile idiopathic arthritis
AU - Hissink Muller, P. C. E.
AU - van Braak, W. G.
AU - Schreurs, D.
AU - Nusman, C. M.
AU - Bergstra, S. A.
AU - Hemke, R.
AU - Schonenberg-Meinema, D.
AU - van den Berg, J. M.
AU - Kuijpers, T. W.
AU - Koopman-Keemink, Y.
AU - van Rossum, M. A. J.
AU - van Suijlekom-Smit, L. W. A.
AU - Brinkman, D. M. C.
AU - Allaart, C. F.
AU - ten Cate, R.
AU - Maas, M.
PY - 2019/9/4
Y1 - 2019/9/4
N2 - Background: To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-To-Target. Methods: Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration. Results: In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from-0,82; 0.68), nor for BA (varying from-0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (-1.48;-0.68) compared to arm 1 (-0.84;-0.04) and arm 2 (-0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1). Conclusions: Recent-onset JIA patients, treated-To-Target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment. Trial registration: NTR, NL1504 (NTR1574). Registered 01-06-2009.
AB - Background: To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-To-Target. Methods: Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration. Results: In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from-0,82; 0.68), nor for BA (varying from-0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (-1.48;-0.68) compared to arm 1 (-0.84;-0.04) and arm 2 (-0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1). Conclusions: Recent-onset JIA patients, treated-To-Target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment. Trial registration: NTR, NL1504 (NTR1574). Registered 01-06-2009.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85071765293&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31484539
U2 - https://doi.org/10.1186/s12969-019-0362-1
DO - https://doi.org/10.1186/s12969-019-0362-1
M3 - Article
C2 - 31484539
SN - 1546-0096
VL - 17
JO - Pediatric Rheumatology
JF - Pediatric Rheumatology
IS - 1
M1 - 62
ER -