Disease activity of idiopathic juvenile arthritis continues through adolescence despite the use of biologic therapies

Abstract

Objectives: To investigate the use of DMARDs and biologic treatments and disease activity in patients with JIA referred to the adult rheumatology clinic and to provide further information regarding the need for long-term rheumatologic care.

Methods: We studied the data of 154 patients retrospectively from hospital records if they met the following criteria: diagnosis of JIA and at least one visit to the adult rheumatologic unit. Previous and current antirheumatic treatment, duration of biologic therapy and disease activity were recorded.

Results: At the end of patient follow-up, the median age of the eligible patients was 19 years (range 16-24 years) and the disease duration was 8 years (range 0-20 years). Twenty-nine per cent of the patients were still on biologic therapies. The total median duration of treatment with at least one biologic agent was 4.2 years, and 44% of treatment durations lasted >5 years. Some disease activity was present in the last year in 58% of patients. Activity in the temporomandibular joint was detected in 14% and uveitis in 8%. Thirteen per cent did not need further specialist care and in 14% all antirheumatic medication could be tapered off.

Conclusion: Almost one-third of adolescents and young adults with JIA who needed specialist care were on biologics. The need for treatment in many cases is long term (>5 years). Most patients (58%) still showed evidence of mild disease activity. Adolescents and young adults with JIA are a distinct patient group in adult health care and a specialized multidisciplinary approach to treatment is needed.

Keywords: adolescents; arthroplasty; biologic therapy; disease activity; disease-modifying antirheumatic drug; juvenile idiopathic arthritis; temporomandibular joint; uveitis.