Treatment Escalation Decisions in JIA Best Supported by Simple Assessment Score, Study Suggests

Treatment Escalation Decisions in JIA Best Supported by Simple Assessment Score, Study Suggests

A tool called the clinical Juvenile Arthritis Disease Activity Score (cJADAS) for measuring disease activity in patients with juvenile idiopathic arthritis (JIA) is more accurate in determining the need for treatment escalation compared to currently used assessments, researchers found.

The study, published in the journal Annals of the Rheumatic Diseases, also demonstrated that many children in need of treatment with TNF-blockers do not receive such drugs.

Although biological treatments, such as anti-TNF medications, have improved outcomes in JIA, researchers at the University Medical Center Utrecht in the Netherlands noted that research has not established which patients may likely benefit from such treatment.

This uncertainty results in a situation where less than 20 percent of patients receive such treatment, they said.

To examine different ways of assessing patients, the study, “Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis,” compared different methods: cJADAS, JADAS, and the American College of Rheumatology clinical practice guidelines (ACR-CPG).

The JADAS consists of four assessments: joint count, a physician global assessment, a parent or patient assessment of well-being, and the erythrocyte sedimentation rate (ESR). cJADAS excludes the ESR measure.

The goal was to correctly identify JIA patients in need of anti-TNF therapy three and six months after start of treatment with methotrexate — a first-line anti-rheumatic drug.

Researchers recruited 145 patients with JIA starting their first treatment with methotrexate. The team looked separately at patients with fewer than five affected joints — oligoarticular JIA — and polyarticular JIA, with more than five affected joints.

Results showed that the use of cJADAS in identifying patients in need of anti-TNF therapy outperformed the ACR-CPG with a much higher sensitivity, specificity, and accuracy.

The team reported that the ACR clinical practice guidelines recommended escalation from methotrexate to TNF-blockers in 65% of assessments, while the cJADAS recommended it in only 12% of the cases. The decision not to escalate was correct in 70 to 75% of the assessments as shown by the patient’s response to methotrexate treatment.

Since cJADAS is a much simpler assessment tool than the ACR-CPG evaluation, the team suggested it may be used to assess treatment escalation in JIA patients.

More research validating these findings is, however, necessary before the practice can be established, they said.

“The cJADAS identifies patients in need of anti-TNF and is a user-friendly tool ready to be used for treat to target in JIA,” the team concluded.

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