Among patients with juvenile idiopathic arthritis (JIA), those who have a longer disease duration — up to 10 years — are more likely to achieve remission, a review study suggests.
The study “How common is remission in juvenile idiopathic arthritis: A systematic review” was published in the journal Seminars in Arthritis and Rheumatism.
JIA is the most common chronic rheumatic disease of childhood, and JIA’s treatment goal is disease remission. The definition of remission, however, varies across clinical trials. The frequency with which JIA patients achieve remission has also never been put to systematic review.
A research team proposed to evaluate the different definitions of remission used across JIA patient groups, and assess remission frequency overall and within individual disease categories.
“Knowledge of the frequency of remission across clinical cohorts would provide an insight into the past and current disease course of JIA, both overall and within specific disease categories,” the researchers wrote.
The team searched for articles, published between 1972 and 2015, in three databases: Medline, Embase and PubMed. Selected studies had to estimate remission rates in groups of more than 50 patients, and remission assessment could not follow a specific medical intervention, among other parameters.
“Of 2428 unique articles identified, 17 were selected for inclusion to the systematic review,” the team wrote.
Researchers identified 13 different sets of criteria for remission or clinically inactive disease in these studies. Only seven applied the Wallace’s Preliminary Criteria — the first validated set of criteria for remission in JIA — while the trial’s investigators defined most criteria used in the remaining 10 studies.
Female patients composed the majority of the cohorts studied (88%), showing a disease duration that ranged from six months to 17 years.
Analysis revealed that the frequency of remissions increased with disease duration – 7% within 1.5 years to 47% by 10 years following diagnosis. After 10 years, the percentage of remissions dropped, with less than half of the patient’s achieving it.
In agreement with previous studies, researchers observed that patients with persistent oligoarticular JIA — the most common type of JIA among young patients — were most likely to achieve remission. Those with rheumatoid factor-positive polyarticular JIA were the least likely to enter remission.
“Achievement of remission increased with longer disease duration, but many patients remain in active disease, even in contemporary cohorts,” the study concludes.
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