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. 2025 Jul 22;23(1):77.
doi: 10.1186/s12969-025-01130-2.

Disease activity at two consecutive registry visits and subsequent medication escalation for patients with juvenile idiopathic arthritis in the CARRA registry

Melissa L Mannion  1 , Monica S Aswani  2 , K Ria Hearld  2 , Emily A Smitherman  2 , Livie Timmerman  2 , Jeffrey R Curtis  2 ; CARRA Registry Investigators
Collaborators, Affiliations

Disease activity at two consecutive registry visits and subsequent medication escalation for patients with juvenile idiopathic arthritis in the CARRA registry

Melissa L Mannion et al. Pediatr Rheumatol Online J. .

Abstract

Objective: To account for the chronic time course of juvenile idiopathic arthritis (JIA), we assessed medication changes by disease activity patterns across 2 sequential timepoints.

Methods: Patients with non-systemic JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry with complete clinical Juvenile Arthritis Disease Activity Scores (cJADAS) at 6 and 12-month registry visits were included. Disease activity was classified by cJADAS categories (inactive/minimal, moderate/high). The primary outcome was disease modifying anti-rheumatic drug (DMARD) escalation at the 12-month visit. We examined the association between cJADAS patterns and DMARD escalation.

Results: The cJADAS patterns across paired visits for 2,956 patients with JIA were: 71% persistent inactive/minimal, 25% persistent moderate/high, 2% "improving", and 2% "flaring". Only 10% of patients had DMARD escalation at the 12-month visit, including only 15% of patients with persistent moderate/high disease activity. In multivariable logistic regression adjusting for sociodemographic and clinical variables, DMARD escalation at the 12-month visit was associated with "flaring" disease activity (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.33-5.18), DMARD escalation between the 6- and 12-month visits (OR 1.86, 95% CI 1.40-2.49) and morning stiffness (> 60 min 4.98, 95% CI 3.00-8.27), while age 15-19 years were less likely to escalate (OR 0.61, 95% CI 0.38-0.97).

Conclusion: In a large multicenter registry of US patients with JIA, DMARD escalation at the 12-month visit was uncommon overall, even for those with persistent moderate/high disease activity. Our findings suggest that DMARD escalation in this cohort did not align well with a treat to target approach using cJADAS thresholds.

Keywords: Antirheumatic agents; Juvenile idiopathic arthritis; Patient reported outcome measures; Registries; Treatment outcome.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Participants provide written informed consent and assent, when applicable, for enrollment in the CARRA Registry. The University of Alabama at Birmingham Institutional Review Board approved this retrospective analysis (IRB-170112004). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pattern of cJADAS disease activity at the 6- and 12- month registry visit by medication escalation at the 12-month visit (+ 30 days)
See this image and copyright information in PMC

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