What is the best strategy to achieve remission in juvenile idiopathic arthritis?

This study investigated three treatment strategies to achieve remission in patients with juvenile idiopathic arthritis (JIA). They found that all treatment strategies were effective in achieving remission in JIA.

Juvenile idiopathic arthritis (JIA) is caused by inflammation. It causes painful swelling in the joints of children. If JIA is not treated properly, children can develop joint damage and disability. Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed to treat JIA.

Research suggests that treating JIA early in the disease improves the chance of achieving remission. Remission is a state where the disease is inactive. During remissions, patients have low or no disease symptoms. Also, joint damage is not progressing. In order to achieve remission, different medications including DMARDs can be used. It is unclear if certain JIA treatment strategies are more effective at achieving remission. 

This study included 94 children with JIA. Patients were randomly assigned to one of three treatment groups. Group 1 received sulfasalazine (SFZ; Azulfidine) followed by methotrexate (MTX). Group 2 received a combination of MTX and 6 weeks of prednisolone (PRD). Group 3 received MTX and etanercept (ETN; Enbrel). The target was to achieve remission at 6 months. Patients were followed up to 24 months. 

On average, remission was achieved after 9 months of treatment in all three groups. After 24 months, remission was achieved in 71% of patients in group1, 70% in group 2 and 72% in group 3. 45% of patients in group 1, 31% in group 2 and 41% in group 3 were drug-free and in remission at 24 months.

Side effects were similar in all groups. The most common included gastrointestinal (gut) complaints and upper respiratory tract infections. 

The authors concluded that all treatment strategies were effective in achieving remission in JIA.

The number of patients in this study was relatively small. The authors noted some changes in treatment during the study. This may have had an effect on the results. 

If you have any concerns regarding JIA treatment, please consult with your physician.