Systemic glucocorticoids are commonly used as short-term bridging treatment to control disease activity in juvenile idiopathic arthritis (JIA). This study aimed to analyze the factors affecting the use of systemic glucocorticoid treatment and cumulative dose during the first year after JIA diagnosis. This retrospective study included children who were diagnosed with JIA according to the International League for Rheumatology (ILAR) classification criteria, excluding systemic JIA, and followed up for at least 1 year. All systemic glucocorticoid treatments administered during follow-up were converted to prednisolone-equivalent doses, and the total cumulative dose was calculated for each patient. The study included 164 patients (53% female), of whom 110 (67.1%) received systemic glucocorticoid treatment. Higher baseline Juvenile Arthritis Disease Activity Score-71 (JADAS-71) scores (OR: 1.149, 95% CI: 1.003-1.316, p=0.045) and ankle joint involvement (OR: 5.740, 95% CI: 1.134-29.050, p=0.035) were associated with an increased use of systemic glucocorticoid treatment, while enthesitis-related arthritis (ERA) was associated with a decreased use (OR: 0.132, 95% CI: 0.036-0.487, p=0.002). Ankle involvement (β: 1.434, 95% CI: 0.328-2.539, p=0.012), antinuclear antibody (ANA) positivity (β: 1.232, 95% CI: 0.181-2.283, p=0.022), and higher baseline JADAS-71 scores (β: 0.101, 95% CI: 0.001-0.202, p=0.046) were strongly associated with increased cumulative systemic glucocorticoid dose. To our knowledge, this is the first study to comprehensively evaluate the factors influencing the use of systemic glucocorticoid treatment and cumulative dose in patients with JIA. Our findings emphasize disease subtypes, specific joint involvements, ANA positivity, and disease activities in this regard.
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Renal involvement in juvenile idiopathic arthritis (JIA) is uncommon (observed in 8.5% of our cohort) and may arise from either the disease itself or its medications. However, differences in renal manifestations across JIA subtypes remain poorly characterized. To investigate the prevalence, risk factors, and prognostic implications of renal involvement, and to characterize the nature of renal manifestations across JIA subtypes. A retrospective cohort study was conducted involving 376 JIA patients treated from May 2015 to May 2022. Data on medications, laboratory findings, subtypes, and disease activity were analyzed. Renal involvement rates by subtype were as follows: systemic JIA (SJIA, 16.2%), rheumatoid factor (RF)-positive polyarticular JIA (9.5%), enthesitis-related arthritis (ERA, 8.5%), oligoarticular JIA (OJIA, 6.3%), and RF-negative polyarticular JIA (3.4%). SJIA patients with renal involvement all had proteinuria and high serum amyloid A levels. All non-systemic JIA patients had hematuria (two with proteinuria). Only polyarticular JIA patients with renal involvement showed elevated interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels. In contrast, ERA and OJIA patients had no IL-6/TNF-α changes, regardless of renal involvement. ERA cases also had elevated serum IgA. Cox regression analysis revealed that elevated C-reactive protein (HR 1.039, p < 0.001), higher Juvenile Arthritis Disease Activity Score in 27 joints (HR 1.160, p < 0.001), and longer duration of active disease (HR 1.052, p = 0.008) independently predicted renal involvement, whereas biologics were protective (HR 0.394, p = 0.043). All patients were followed up for at least 24 months. At final follow-up, renal involvement resolved in 81.3% of JIA patients, including all SJIA and OJIA cases, but only 25% of RF-positive polyarticular JIA patients. This study provides preliminary evidence of distinct patterns of renal involvement across JIA subtypes. The findings support the hypothesis that controlling active disease
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To identify predictors of clinically inactive disease (CID) and clinical remission (CR) in patients with juvenile idiopathic arthritis receiving etanercept during the 2-year, phase 3b, open-label CLIPPER study (NCT00962741) and the 8-year extension study, CLIPPER2 (NCT01421069). Patients with extended oligoarthritis (2-17 years), enthesitis-related arthritis or psoriatic arthritis (each 12-17 years) were enrolled in CLIPPER/CLIPPER2. Predictors of CID (according to Juvenile Arthritis Disease Activity Score [JADAS] and JIA-ACR response criteria) and CR (≥6 months of CID) were identified using a multivariate stepwise logistic regression model. Two-thirds of patients met the criteria for CID at any point and 34-43% achieved CR. Height Z-score ≥0.74, age at onset ≤12 years, normal CRP levels, HLA-B27+ status, JADAS low disease activity (LDA) at 3 months and ≤4 swollen joints were predictive of JADAS CID. BMI Z-score >0.80, age at onset ≤12 years, normal CRP levels and JADAS LDA at 3 months were predictors of JIA-ACR CID. JADAS LDA at 3 months was a predictor of JADAS CR, and height Z-score >1.23, JADAS LDA at 3 months and >12 swollen joints were identified as predictors of JIA-ACR CR. In patients with JIA treated with etanercept, early responses to treatment in line with treat-to-target recommendations, younger age, HLA-B27+ status and lower disease activity at baseline were associated with clinically inactive disease and clinical remission. ClinicalTrials.gov IDs: CLIPPER (NCT00962741); CLIPPER2 (NCT01421069).
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