Juvenile arthritis patients younger than 8 whose disease is less advanced and who have lower levels of an inflammation marker are the likeliest to respond to a stand-alone, non-steroid anti-inflammatory therapy, a study reports.
The team published its findings on non-steroid anti-inflammatory therapies, or NSAIDs, in the journal Pediatric Rheumatology. The title of their article is “Patient characteristics associated with response to NSAID monotherapy in children with systemic juvenile idiopathic arthritis.”
Advances in knowledge about juvenile arthritis and the development of better therapies for preventing joint damage have improved patient outcomes in the past 20 years.
Four classes of drugs are available for children with arthritis: NSAIDs, corticosteroids, disease-modifying anti-rheumatic drugs, or DMARDs, and biologic agents. Each class has characteristics that make them more suitable to treating particular patients.
Doctors have limited treatment-comparison information to help them come up with therapy recommendations. This means many recommendations are based on expert consensus, which for specific children may not represent the best risk-benefit balance.
A University of Michigan team decided to see which kinds of juvenile arthritis patients responded best to NSAID standalone therapy.
The study covered 87 children diagnosed with the disease between 2000 and 2014 at a care center. Fifty-one received a stand-alone NSAID therapy.
The most prescribed drug was naproxen, followed by indomethacin, sulindac and ibuprofen. Each is sold under several brand names.
Only 13, or 26 percent, of the children who received an NSAID had their disease become inactive without other medications.
The children who responded best to an NSAID stand-alone therapy were those aged 8 and younger, whose arthritis affected five or fewer joints, and who had lower levels of the inflammation marker C-reactive protein.
“In combination within the same patient, these three variables yield a very strong association with response to NSAID monotherapy,” the researchers wrote.
“The group that is predisposed to achieve CID [a clinically inactive disease] with NSAID monotherapy does so quickly (median time to CID was 49 days),” the team wrote. “So if a significant response is not achieved within two to four weeks, medications should be transitioned to alternative first- and second-line agents, including corticosteroids.”
Researchers said they believe that “this study helps pediatric rheumatologists risk-stratify their patients at diagnosis when choosing whether to pursue a trial of NSAID monotherapy.”
Additional studies are necessary to confirm the findings, the researchers added.
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