Treatment-to-target approach effective in reducing pain levels in juvenile idiopathic arthritis

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The implementation of a treatment-to-target approach demonstrated effectiveness in reducing pain levels in patients with non-systemic juvenile idiopathic arthritis (JIA), regardless of the initial treatment strategy, according to a study.

The study also identified baseline predictors that can aid in identifying patients at a higher risk of developing chronic pain.

The study enrolled 92 patients with JIA who had not been previously treated with Disease-Modifying Antirheumatic Drugs (DMARDs) and randomized them into 3 treatment strategies.

The treatment strategies included: 1) initial sequential DMARD-monotherapy; 2) initial methotrexate (MTX)/prednisolone-bridging; and 3) initial MTX/etanercept. Pain levels were measured using Visual Analog Scale (VAS) scores, ranging from 0 to 100 mm, over a span of 24 months.

The results indicated a substantial reduction in pain scores over time, dropping from an average of 55.3 (SD 21.7) to 19.5 (SD 25.3) mm after 2 years. The monthly average reduction in pain scores was β -1.37 mm (95% CI -1.726; -1.022), indicating a steady improvement.

No significant disparity was observed between the treatment strategies. The interaction term between treatment arm and time did not yield notable differences, with arm 1 showing a β of 0.13 (-0.36; 0.62) and arm 2 exhibiting a β of 0.37 (-0.12; 0.86) compared to arm 3.

The findings remained consistent when sex and symptom duration were accounted for. The study identified several baseline characteristics predictive of pain evolution over time. Notably, higher VAS pain scores and a greater count of actively affected joints correlated with higher levels of pain over time. Conversely, lower VAS physician scores, CHQ Physical, and Psychosocial summary scores were predictive of lower pain levels.

Spekking K, Anink J, de Boer P, et al. Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: results over 24 months of follow up. Pediatr Rheumatol Online J. 2023;21(1):90. doi: 10.1186/s12969-023-00874-z. PMID: 37633893; PMCID: PMC10464062.