Juvenile arthritis: can we predict disease progression and improve treatment outcomes?

This study investigated the factors that may predict disease progression in patients with juvenile idiopathic arthritis (JIA). They found that prediction models based on clinical factors can predict the likelihood of achieving remission and the level of disability long-term.

Juvenile idiopathic arthritis (JIA) is a condition that causes painful swelling and inflammation in the joints of children. The severity and speed at which the disease progresses can vary between patients.

JIA is treated using drugs to reduce inflammation. Reducing inflammation relieves pain and helps limit tissue damage in the joints. However, some patients will have more severe symptoms and faster disease progression than others. Some of these drugs are expensive and can have toxic side effects. It would be better to give these medications to patients at high risk of developing severe symptoms. This could avoid exposing children to unnecessary treatment.

This study investigated the factors that may predict the severity of disease in JIA.

This study included 423 patients with JIA. Patients were assessed 6 months following diagnosis of JIA (baseline data). Patients and/or their parents completed health questionnaires, and symptoms were measured using several scoring systems. Laboratory tests were also performed. This assessment was performed again at 8 years after disease onset. The authors chose a set of factors related to JIA to create a prediction model. These factors included number of involved joints, morning stiffness, ankle joint arthritis, and a number of blood tests that indicate inflammation and tissue damage. 

At 8 years, 60% of children were not in remission (still have symptoms). The models acceptably predicted the likelihood of patients not achieving remission. They also predicted the level of disability and joint damage at 8 years, based on baseline data.

The authors concluded that prediction models based on clinical factors can predict the likelihood of achieving remission and the level of disability long-term.

In this case, follow-up assessment was only performed at 8 years. During this time, patients may have experienced remission. This prediction model should be tested at multiple intervals following diagnosis. This will provide a clearer picture on how useful prediction models might be to treat JIA.

If you have any questions relating to treatment of JIA, please consult with your or your child’s physician.