Clinical Outcome and Long-term Remission in JIA

Abstract

Purpose of review: This review assesses the long-term remission and predictors of clinical outcome in patients with juvenile idiopathic arthritis (JIA). A comprehensive literature search was performed including articles published between January 1, 2004 and February 28, 2017. Studies, with a minimum follow-up of 24 months, were selected independently by two reviewers based on in- and exclusion criteria. The objective outcome was inactive disease/clinical remission as defined by the Wallace criteria at last follow-up.

Recent findings: The probability of achieving inactive disease and/or clinical remission is dependent on the JIA subcategories studied in the different articles. Overall, a significant proportion of JIA patients still showed signs of active disease at last follow-up. Some studies include patient populations followed for 15 years or more and these patients were exposed to different treatment protocols at disease presentation than patients diagnosed in the biologic era. Although the severity of the morbidity and associated mortality risk has decreased over time, a significant proportion of the current JIA patients still do not reach an inactive disease status within a 2-year follow-up window. Studying the long-term outcome of patients with JIA remains challenging due to the heterogeneity of the study designs and study populations. Although improvement has been shown in the biologic era, we still need to enhance the number of patients with inactive disease within the first 2 years after diagnosis.

Keywords: Arthritis; Childhood; Juvenile idiopathic arthritis; Outcome; Remission.