Juvenile Idiopathic Arthritis: Towards Improving Clinical Care

Abstract

In this thesis, the results are described of a randomized multicenter treatment-to-target study in early-onset, non-systemic Juvenile Idiopathic Arthritis (JIA) with 2 years of follow-up. The treatment arms consisted of 1) initial monotherapy with methotrexate or sulfasalazine, 2) initial treatment with methotrexate and prednisolone and 3) initial treatment with etanercept and MTX. If preset goals (ACRpedi50% after 3months and inactive disease from 6 months and onwards) were not met, therapy was adjusted with tight control. If inactive disease lasted at least 6 months, therapy was tapered and stopped. After three months of treatment, significantly more ACRPedi70% was found in arm 3. After two years of follow-up in all three arms approximately 70% of patients had reached inactive disease and up to 39% of patients was drug-free. Wrist radiographs of the patients did not show damage at the start of the study, nor during follow-up. The conclusions of this thesis are that inactive disease is a feasible goal in the treatment of JIA if treatment-to-target is applied with tight control. In our study, tight control seems more important than the initial medication. Tapering strategies can be applied in treatment-to-target strategies to reach drug-free inactive disease in JIA.