Objectives: We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints. Methods: Joints of 91 patients of... Show moreObjectives: We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints. Methods: Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA, were clinically assessed during 2 years (10 study visits). The association between joint inflammation at baseline and later inflammation in the same joint was assessed using a multilevel mixed-effects logistic regression model at joint level. With a Poisson model, the association between baseline joint inflammation and the number of study visits at which the same joint was recurrently inflamed was tested. Results: Of the 6097 joints studied, 15% (897) was clinically inflamed at baseline. In 42% (377/897) of those joints, inflammation recurred during follow-up. Joint inflammation at baseline was statistically significantly associated with joint inflammation during follow-up in the same joint (OR 3.9, 95% CI 3.5 to 4.4) and specifically with the number of episodes of recurrent joint inflammation (IRR 1.6, 95% CI 1.2 to 2.1). Conclusion: In JIA, joint inflammation has the tendency to recur multiple times in joints that are clinically inflamed at disease onset. This indicates that local factors might play a role in the processes contributing to the occurrence of JIA flares. Show less
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... Show moreIn 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. Show less
