Adherence to treat-to-target recommendations in juvenile idiopathic arthritis in clinical practice.

objectiveTo assess adherence to Treat-to-Target (T2T) recommendations for juvenile idiopathic arthritis (JIA) in clinical practice.

methodsA nested cohort study in the multicenter international prospective UCAN JIA cohort was performed. Patient characteristics, clinical features, classification, disease activity as measured by number of active joints (AJC), Physician Global Assessment (PhGA) and Patient Global Assessment (PPGA) and treatment at baseline and six-months visit was assessed. Data were compared to published, consensus-based T2T recommendations. Logistic regression with step-wise selected variables identified factors related to the decision to change therapy.

resultsA total of 476 children were included, 62% female, median age was 10.0 years. At baseline, anti-inflammatory medications (NSAID) and/or intra-articular injections were started in 53%, conventional synthetic anti-rheumatic drugs (csDMARD) in 37% and biologic therapies in 11%. At six-months, 248 patients (52%) had inactive arthritis based on AJC. PPGA was not collected for 35% of patients. In children with arthritis, treatment change as suggested in the recommendations were only made in 33%. Patients that had no treatment change were more often already treated with a csDMARD or biological or had limited number of joints affected. Multivariate logistic regression showed that the decision to change treatment at six-months was significantly related to PhGA, prior treatment changes and use of csDMARD or biological since baseline.

conclusionPPGA is not consistently collected, hampering measurement-based care and T2T. PhGA and prior treatment steps are underlying current treatment decisions, but often not according to the T2T cut-offs and time-points that have been agreed upon in consensus.