Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Patterns of Non-Steroidal Anti-Inflammatory Drug Use for Juvenile Idiopathic Arthritis in the Era of Modern Aggressive Treatment

Kochar1,  Rabina, Spalding2,  Steven J., Jain2,  Anil, Walsh3,  Kyle M., Hashkes2,  Philip J.

Cleveland Clinic Lerner College of Medicine, Cleveland, OH
Cleveland Clinic, Cleveland, OH
Yale University School of Public Health, New Haven, CT

Purpose:

To describe trends in NSAID use for JIA and explore factors associated with anti-inflammatory use of NSAIDs by conducting a retrospective cohort study of treatment of patients with JIA.

Method:

Through our electronic health record (EHR) system, we identified all individuals seen in pediatric rheumatology from 1/2003 to 6/2008 with a diagnosis of JIA. Subjects were excluded if they did not meet criteria for JIA or were seen only for a second opinion. Of 377 eligible patients, 100 were randomly selected for detailed analysis (EHR measureable characteristics not significantly different than the entire cohort, including medication use). Longitudinal data was extracted through a combination of manual review and automated extraction from the EHR. Background demographics and disease type data were collected, and data for disease activity status (number of active joints, joints with LOM, CHAQ score, pain score, physician assessment, inflammatory labs), medication use (NSAIDs, and other JIA medications) and adverse events were collected for each outpatient encounter. Longitudinal data were analyzed for factors predictive of NSAID use at an anti-inflammatory dose using Nonlinear Mixed Effects Regression analysis accounting for intra-subject correlation.

Results:

 N=100 
 Nn
DEMOGRAPHICS  
Sex (Female)66
Ethnicity (Caucasian)87
Oligoarticular49
Systemic5
Polyarticular RF-25
Polyarticular RF+2
Enthesitis-related6
Psoriatic6
Other7
MEDICATIONSEver usedUsed at last visit
NSAID any dose9040
NSAID anti-inflammatory4019
Methotrexate5842
Other DMARD144
Biologic1717
Intra-articular Injection45
Oral Corticosteroids113

56% of patients were in a state of inactive disease and 20% had one active joint at last visit. NSAID use decreased by >50% over the study period. Less than 50% of NSAID users used at an anti-inflammatory dose. Factors associated with anti-inflammatory use included year of visit (OR = 0.605 for each subsequent year since 2003; p = 0.0076), number of joints with active arthritis (OR = 1.26 per joint; p = 0.0047), number of joints with limitation of motion (OR = 1.12 per joint; p = 0.0189), uveitis (OR = 0.013; p = 0.0078), and use of MTX (OR = 0.053; p = 0.023). The number of patients on biologics was not sufficient to analyze their effect on NSAID use.

Conclusion:

While NSAIDs were used at some point by nearly all patients, only a minority ever used NSAIDs at an anti-inflammatory dose. This proportion of all types of NSAID use significantly decreased over time. Reduced anti-inflammatory use was associated with decreased disease activity, use of MTX, and treatment of isolated uveitis. The role of NSAIDs in treating JIA has changed markedly since past literature reports from the 1990s.

To cite this abstract, please use the following information:
Kochar, Rabina, Spalding, Steven J., Jain, Anil, Walsh, Kyle M., Hashkes, Philip J.; Patterns of Non-Steroidal Anti-Inflammatory Drug Use for Juvenile Idiopathic Arthritis in the Era of Modern Aggressive Treatment [abstract]. Arthritis Rheum 2009;60 Suppl 10 :235
DOI: 10.1002/art.25318

Abstract Supplement

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