Health-related quality of life during early aggressive treatment in patients with polyarticular juvenile idiopathic arthritis: results from randomized controlled trial

Maarit Tarkiainen, Pirjo Tynjälä, Paula Vähäsalo, Liisa Kröger, Kristiina Aalto, Pekka Lahdenne, Maarit Tarkiainen, Pirjo Tynjälä, Paula Vähäsalo, Liisa Kröger, Kristiina Aalto, Pekka Lahdenne

Abstract

Background: Juvenile Idiopathic Arthritis (JIA) may cause significant impairment in health-related quality of life (HrQoL), despite effective therapies. The aim of this study was to assess HrQoL during first-year treatment in patients with new-onset polyarticular JIA, and to compare treatment strategies.

Methods: In ACUTE-JIA Study, 60 patients with new-onset JIA were randomized to receive either infliximab with methotrexate (IFX+MTX); a triple therapy of methotrexate, hydroxychloroquine, and sulfasalazine (Triple); or methotrexate monotherapy (MTX). Efficacy was measured with American College of Rheumatology pediatric (ACRp) score, and juvenile arthritis disease activity score (JADAS). HrQoL was evaluated with Child Health Questionnaire (CHQ), which includes physical and psychosocial summary scores (PhS and PsS). Linear mixed models were utilized to compare groups over time.

Results: In the whole group of 60 patients, mean physical summary score (PhS) improved from 26.2 (SD 8.7) at week 0 to 49.7 (SD 13.2) at week 54 (p=0.046). Mean improvement of PhS was 20.3 (95% CI -15.5 to 56.2); 22.6 (-19.5 to 64.7); and 26.6 (-12.1 to 65.3) in IFX+MTX, Triple, and MTX, respectively. Changes in psychosocial summary score (PsS) were smaller: from 51.0 (SD 8.5) to 54.7 (6.3) (p=0.019) in all patients. No differences between the three treatment groups were detected in either of the measures. In multivariate analyses, Child Health Assessment Questionnaire (CHAQ), pain VAS, and time spent in inactive disease contributed to improvement in PhS; gender and CHAQ to PsS.

Conclusions: HrQol improved during the first year on therapy for JIA irrespective of the treatment strategy. The timing of change in the different dimensions of HrQoL varied; improvement occurred earlier in physical than psychosocial domains of HrQol.

Trial registration: This study was registered within the Hospital District of Helsinki and Uusimaa (http://www.hus.fi) clinical trials, number 211864 in October 2002, and later on with ClinicalTrials.gov, number NCT01015547.

Keywords: DMARDs; Early aggressive treatment; Health-related Quality of Life; Infliximab; Juvenile Idiopathic Arthritis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Evolution of health-related quality of life during first year in patients with JIA

References

    1. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;4(273):59–65. doi: 10.1001/jama.1995.03520250075037.
    1. Oen K, Tucker L, Huber AM, Miettunen P, Scuccimarri R, Campillo S, et al. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: results of a Canadian multicenter, prospective inception cohort study. Arthritis Rheum. 2009;61(8):1077–1086. doi: 10.1002/art.24539.
    1. Wipff J, Sparsa L, Lohse A, Quartier P, Kahan A, Deslandre CJ. Impact of juvenile idiopathic arthritis on quality of life during transition period at the era of biotherapies. Joint Bone Spine. 2016;83(1):69–74. doi: 10.1016/j.jbspin.2015.03.005.
    1. Listing M, Monkemoller K, Liedmann J, Niewerth M, Sengler C, Listing J. et al. The majority of patients with newly diagnosed juvenile idiopathic arthritis achieve a health-related quality of life that is similar to that of healthy peers: results of the German multicenter inception cohort (ICON). Arthritis Res Ther 2018; 20(1):106,018-1588-x.
    1. Oen K, Guzman J, Dufault B, Guzman J, Lim H, Lee C, et al. Health-Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis. Arthritis Care Res (Hoboken) 2018;70(1):134–144. doi: 10.1002/acr.23236.
    1. Seid M, Opipari L, Huang B, Brunner HI, Lovell DJ. Disease control and health-related quality of life in juvenile idiopathic arthritis. Arthritis Rheum. 2009;61(3):393–399. doi: 10.1002/art.24477.
    1. Tynjala P, Vahasalo P, Tarkiainen M, Kroger L, Aalto K, Malin M, et al. Aggressive combination drug therapy in very early polyarticular juvenile idiopathic arthritis (ACUTE-JIA): a multicentre randomised open-label clinical trial. Ann Rheum Dis. 2011;70(9):1605–1612. doi: 10.1136/ard.2010.143347.
    1. Wallace CA, Ruperto N, Giannini E. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol. 2004;31(11):2290–2294.
    1. Child Health Questionnaire (CHQ). Scoring and Interpretation Manual. Cambridge, MA 02141: HealthActCHQ, Inc., 2008.
    1. Tollisen A, Selvaag AM, Aulie HA, Lilleby V, Aasland A, Lerdal A, et al. Physical Functioning, Pain, and Health-Related Quality of Life in Adults With Juvenile Idiopathic Arthritis: A Longitudinal 30-Year Followup Study. Arthritis Care Res (Hoboken) 2018;70(5):741–749. doi: 10.1002/acr.23327.
    1. Lovell DJ, Ruperto N, Mouy R, Paz E, Rubio-Perez N, Silva CA, et al. Long-term safety, efficacy, and quality of life in patients with juvenile idiopathic arthritis treated with intravenous abatacept for up to seven years. Arthritis Rheumatol. 2015;67(10):2759–2770. doi: 10.1002/art.39234.
    1. Brunner HI, Klein-Gitelman MS, Miller MJ, Trombley M, Baldwin N, Kresset A, et al. Health of children with chronic arthritis: relationship of different measures and the quality of parent proxy reporting. Arthritis Rheum. 2004;51(5):763–773. doi: 10.1002/art.20689.
    1. Shiff NJ, Tupper S, Oen K, Guzman J, Lim H, Lee CH, et al. Trajectories of pain severity in juvenile idiopathic arthritis: results from the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort. Pain. 2018;159(1):57–66. doi: 10.1097/j.pain.0000000000001064.
    1. Klotsche J, Minden K, Niewerth M, Horneff G. Time spent in inactive disease before MTX withdrawal is relevant with regard to the flare risk in patients with JIA. Ann Rheum Dis. 2018;77(7):996–1002. doi: 10.1136/annrheumdis-2017-211968.
    1. Tarkiainen M, Tynjala P, Vahasalo P, Lahdenne P. Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting. Rheumatology (Oxford) 2015;54(7):1170–1176. doi: 10.1093/rheumatology/keu457.

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