Effective Treatment-to-Target Approach for Nonsystemic JIA Pain Reduction and Predictors

Use of a treatment-to-target approach effectively reduced pain among patients with nonsystemic juvenile idiopathic arthritis (JIA), regardless of their initial treatment strategy. Researchers also identified baseline predictors for long-term pain, which can assist in identifying patients at high risk for chronic pain development, according to study results published in Pediatric Rheumatology Online Journal.

The researchers compared pain scores among 3 targeted treatment strategies and identified characteristics that can predict the persistence of pain among children with nonsystemic JIA.

The multicenter randomized single-blinded Best-for-Kids trial was conducted in the Netherlands. Children aged from 2 to 16 years with newly diagnosed non-systemic JIA who had not undergone disease-modifying antirheumatic drug (DMARD) treatment were included in the analysis.

Patients were randomly assigned to 1 of 3 treatment strategies: arm 1) initial treatment with methotrexate (MTX) or sulfasalazine monotherapy; arm 2) initial treatment with MTX and 6 weeks prednisolone bridging; and arm 3) initial treatment with etanercept and MTX.

Patients were treated to the target goal of inactive disease. Pain intensity was the primary outcome, measured using the 100 mm visual analogue scale (VAS).

Following exclusion, 92 patients with JIA were included in the analysis, with 31 patients allocated to arm 1, 32 patients in arm 2, and 29 patients in arm 3.

Two patients, one lost to follow-up at visit 2 and the other at visit 5, were included in the final analysis.

Over 24 months, pain scores decreased from an initial mean score of 55.3 mm (SD, 21.7 mm) to 19.5 mm (SD, 25.3 mm). On average, pain scores decreased monthly by approximately -1.37 mm (95% CI, -1.726 to -1.022).

No significant difference was observed among treatment strategies, as indicated by the interaction term for treatment arm and time in months (arm 1: β, 0.13; 95% CI, -0.36 to 0.62; and arm 2: β, 0.37; 95% CI, -0.12 to 0.86; compared with arm 3).

At 24 months, 5 children (8%) reported moderate pain during inactive disease, while severe pain was reported by 2 children (3%). These 7 patients had a baseline VAS pain score that was, on average, 10 mm higher than the rest of the group.

Elevated VAS pain levels (β, 0.44; 95% CI, 0.25-0.65) and increased active joint counts (β, 0.77; 95% CI, 0.19-1.34) were associated with a higher likelihood of experiencing greater pain over time.

Conversely, lower VAS physician scores (β, -0.34; 95% CI, -0.55 to -0.06), as well as lower child health questionnaire physical (β, -0.42; 95% CI, -0.72 to -0.11) and psychosocial summary scores (β, -0.42; 95% CI, -0.77 to -0.06), were indicative of a reduced likelihood of experiencing higher pain over time.

The findings of this study may be limited due to the small sample size of patients included.

Study authors stated, “We conclude that treat to target therapy is effective in reducing pain over time for DMARD-naive non-systemic JIA patients, irrespective of initial treatment. On the other hand, some children still experience pain despite achieving clinically inactive disease. This emphasizes the necessity of addressing patient related outcomes in addition to targeted treatment to reduce disease activity.”

This article originally appeared on Rheumatology Advisor