Aggressive Trio to Treat Juvenile Arthritis

Juvenile idiopathic arthritis symptoms disappeared with aggressive combination treatment

/ Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

(RxWiki News) Kids as young as toddlers can develop arthritis. Finding the right treatment may help ensure that young lives are not sidelined by this disease, which can affect youths' eyes, joints or other body parts.

New research suggests that early identification and aggressive treatment of juvenile idiopathic arthritis — one form of arthritis in youth — may eliminate its symptoms.

"Ask your child's pediatrician about treatment of juvenile arthritis."

This study was conducted by Carol Wallace, MD, of the Center for Clinical and Translational Research at Seattle Children's Hospital, and colleagues. 

These researchers analyzed data from the clinical "Trial of Early Aggressive Therapy in Polyarticular Juvenile Idiopathic Arthritis," and compared the results of two different, aggressive treatments for 85 juvenile idiopathic arthritis patients.

The patients ranged in age from 2 to 17 years and had an arthritis diagnosis that was less than 12 months old when these therapies began. 

Of the 85 patients, 42 were treated aggressively for six months with weekly injections of methotrexate and etanercept (brand name Enbrel); the dose amounts were based on the patient's weight. Along with those two anti-arthritis medications, the 42 patients took prednisolone, an anti-inflammatory steroid, for the first 17 weeks.

The remaining 43 patients were given methotrexate but with placebos representing etanercept and prednisolone. Placebos contain no medication.

Anyone in either of the two groups who did not experience a 70 percent improvement in their disease after four months of treatment or whose symptoms had not been completely inactive after six months was switched to the more aggressive combination of methotrexate, etanercept and prednisolone.

The researchers were trying to identify which treatments might render juvenile idiopathic arthritis inactive within six months of starting therapy. They also were trying to discover which therapies might keep the disease inactive for six months straight. 

The researchers found that taking those three medications resulted in 30 of the 42 aggressively treated patients being free of symptoms at least once during therapy.

They also found that symptoms disappeared in 28 of the less aggressively treated patients, but 17 of those 28 saw their symptoms disappear after they were switched to the more aggressive trio of medications.

For the aggressively treated group, the median number of days that passed before their symptoms disappeared was 168.5. That compared to a median of 192 days for the less aggressively treated group.

After the initial six months of aggressive treatment, another six months of follow-up showed that the combination therapy patient group spent a median of 139.5 days during which their arthritis was inactive. Patients treated less aggressively experienced a median of 79 days when their arthritis was inactive.

“This study reinforces the importance of treating [juvenile idiopathic arthritis] early and aggressively in order to achieve and sustain clinical inactive disease and clinical remission on medications,” Dr. Wallace said in a press statement.

In addition to affecting the joints, eyes and so on, juvenile idiopathic arthritis can stunt the growth of children who have it. It causes pain, swelling, difficulty walking and other problems.

The National Institute for Arthritis and Musculoskeletal and Skin Diseases and the Howe Endowment for Juvenile Idiopathic Arthritis Research funded this preliminary research.

It was presented October 26 at the American College of Rheumatology Annual Meeting but has not been accepted for publication in a medical journal.

Review Date: 
October 25, 2013
Last Updated:
October 28, 2013