Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Effectiveness of Nonsteroidal Antiinflammatory Drug Monotherapy in Children with Systemic Juvenile Idiopathic Arthritis.

Riebschleger,  Meredith P., Stannard,  Jasmine, Davis,  Matthew M., Clark,  Sarah J., Adams,  Barbara S.

Background/Purpose:

Traditionally, many pediatric rheumatologists have treated systemic juvenile idiopathic arthritis (sJIA) with a pyramid approach, starting with NSAID monotherapy prior to initiating DMARDs or biologic agents. Despite widespread use, the likelihood of response to NSAID monotherapy has not been well characterized. In addition, some clinicians have begun to advocate for the use of biologic agents as first-line therapy for all patients with sJIA, despite potential risks of pain, infection, and malignancy. The goals of this study are (1) to determine the frequency of clinical response to NSAID monotherapy in sJIA, and (2) to identify factors associated with that response.

Methods:

We conducted a single-center cohort study of children aged 0–18 years who were diagnosed with sJIA between 1/1/2000 and 12/31/2009. Children who met ILAR criteria for sJIA and had at least 6 months of follow-up from the time of initial presentation were included. Outcomes included disease quiescence, defined as symptom-free with no active arthritis on exam and normal labs, if done; and remission, defined as disease quiescence off medications. Independent variables included patient demographics, disease characteristics, and medication regimens. Statistical analyses included chi square and Kruskal-Wallis tests for bivariate comparisons and time to event analyses for time to disease quiescence and remission. Continuous variables are presented as medians with interquartile ranges. Categorical variables are presented as frequencies.

Results:

Of the 48 children in the cohort, 35 (73%) underwent an initial trial of NSAID monotherapy. Eight children (23%) experienced disease quiescence on NSAIDs alone and 6 achieved remission. Table 1 compares patient characteristics and clinical outcomes for the 3 groups of children in the cohort. Most children who responded to NSAID monotherapy had improvement within the first 2 months. The median delay to escalation of therapy for children who failed NSAID monotherapy was 1.2 months (IQR 0.7–1.8 months). The clinical outcomes of children who failed NSAID monotherapy were not significantly different than those of children who did not undergo a trial.

Table 1.

 Responded to NSAID monotherapy trial (N=8)Failed NSAID monotherapy trial (N=27)No NSAID monotherapy trial (N=13)p value
Patient Characteristics
  Male38%52%31%42
  Age at presentation (years)2.8 (2.2–4.1)5.4 (2.0–11.7)5.5 (2.1–13.4).24
  Time from onset of symptoms until presentation (years)0.1 (0.1–0.2)0.1 (0.1–0.2)0.2 (0.1–0.3).26
  Hospitalized at presentation13%44%31%.23
  CRP at presentation (mg/dl)7.3 (6.0–8.8)7.4 (5.3–14.1)12.2 (10.3–13.0).09
  Suspected macrophage activation syndrome at presentation0%11%31%.11
  Number of joints involved at presentation2 (1–3)1 (0–5)4 (1–12).50
  Maximum number of joints involved in the first year after presentation2 (2–3)8 (4–18)10 (6–15)<.01
Clinical Outcomes
  Achieved disease quiescence100%85%69%.17
  Time to disease quiescence (years)0.6 (0.4–1.1)1.3 (0.9–2.3)1.0 (0.6–1.6)<.04
  Achieved remission75%59%38%.23
  Time to remission (years)2.1 (1.5–2.4)3.5 (2.6–7.2)3.1 (1.9–4)<.01

Conclusion:

NSAID monotherapy is able to achieve disease quiescence in a subset of children with sJIA. A short trial of NSAID monotherapy does not appear to result in worse outcomes, even for children who fail that trial. These findings indicate that a trial of NSAID monotherapy should be considered for some children with sJIA, prior to starting more aggressive treatment with DMARDs and biologic agents.

To cite this abstract, please use the following information:
Riebschleger, Meredith P., Stannard, Jasmine, Davis, Matthew M., Clark, Sarah J., Adams, Barbara S.; Effectiveness of Nonsteroidal Antiinflammatory Drug Monotherapy in Children with Systemic Juvenile Idiopathic Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :266
DOI:

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