How common is remission in juvenile idiopathic arthritis: A systematic review

Abstract

Objectives: The ideal goal of treatment for juvenile idiopathic arthritis (JIA) is disease remission. However, many sets of remission criteria have been developed and no systematic review of remission in JIA exists. The current systematic review investigated (1) how remission has been defined across JIA clinical cohorts and (2) the frequency of remission overall and within disease categories.

Methods: Studies using prospective inception cohorts published after 1972 were selected if they estimated remission in cohorts of ≥50 patients. Articles focusing on specific medical interventions, not defining remission clearly or not reporting disease duration at remission assessment were excluded. Studies were selected from Medline, Embase, PubMed and bibliographies of selected articles. Risks of selection, missing outcome data and outcome reporting biases were assessed.

Results: Within 17 studies reviewed, 88% had majority female participants and patient disease duration ranged from 0.5 to 17 years. Thirteen sets of criteria for clinically inactive disease and remission were identified. Uptake of Wallace's preliminary criteria was good in studies recruiting or following patients after their publication (78%). Remission frequencies increased with longer disease duration from 7% within 1.5 years to 47% by 10 years following diagnosis. Patients with persistent oligoarticular and rheumatoid-factor positive polyarticular JIA were most and least likely to achieve remission, respectively.

Conclusions: Achievement of remission increased with longer disease duration, but many patients remain in active disease, even in contemporary cohorts. Multiple sets of outcome criteria limited comparability between studies.

Keywords: Clinically inactive disease; Juvenile idiopathic arthritis; Paediatric rheumatology; Remission; Systematic review.

Fig. 1

Number of articles accessed and reviewed to explore the frequency of remission in JIA. “Too specific investigation” refers to inclusion criterion 6 in the text.

Fig. 2

Percentage of patients with JIA in current (A) clinically inactive disease or (B) remission off medication across the literature. Point estimates are stratified based on whether outcome definitions were validated or investigator-defined. Where studies are listed multiple times, multiple sets of outcome criteria have been utilised (Supplementary Table 4).