Attainment of Inactive Dlisease Status Following Initiation of TNF-α Inhibitor Therapy for Juvenile Idiopathic Arthritis: Enthesitis-related Arthritis Predicts Persistent Active Disease

Objective. To analyze the attainment of inactive disease following initiation of tumor necrosis factor-alpha (TNF-alpha) inhibitors in a heterogeneous cohort of children with juvenile idiopathic arthritis (JIA). fMethods. We performed retrospective chart review of all children with JIA at 1 academic center who had started TNF-alpha inhibitor therapy. We retrospectively determined inactive disease status according to the 2004 criteria of Wallace, et al. We evaluated inactive disease status at I year after initiation of TNF-alpha inhibitor and attainment of inactive disease at any point during the study period. Predictors of inactive disease were determined using univariate analyses and multivariable logistic regression models. Results. A total of 125 patients started TNF-alpha inhibitors, and 88 patients had data available for the 1-year followup visit. Many patients (49%) started TNF-alpha inhibitors within 6 months of the diagnosis of JIA. Diverse JIA phenotypes were represented: at baseline, 29% of all patients had active enthesitis and only 23% had active polyarthritis. At the I-year followup, 36 of 88 (41%) patients had inactive disease. Overall, 67 of 125 (54%) patients ever attained inactive disease status during the study period. In multivariable models, enthesitis-related arthritis (ERA) and higher Childhood Health Assessment Questionnaire (CHAQ) scores at baseline were independently associated with failure to later attain inactive disease status. Conclusion. Treatment with TNF-alpha inhibitors appears to be less effective for attaining inactive disease status in patients with ERA or higher baseline CHAQ scores. Further studies are needed regarding the clinical effectiveness of TNF-alpha inhibitor therapy and the optimal treatment of ERA. (First Release Nov 15 2011; J Rheumatol 2011;38:2675-81; doi:10.3899/jrheum.110427)