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Factors determining resistance to conventional disease-modifying anti-rheumatic drug treatment in oligoarticular juvenile idiopathic arthritis

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Abstract

Objective

Our study was designed to investigate the reasons for starting the conventional disease-modifying anti-rheumatic drugs (DMARDs) and the variables that impact the response to DMARD treatment in oligoarticular juvenile idiopathic arthritis (JIA) patients.

Methods

Oligoarticular JIA patients (n = 187) were categorized into two groups: Group A consisted of patients who achieved remission with DMARD, and Group B comprised those who did not respond to DMARD therapy.

Results

DMARDs were initiated for various reasons: 68 (36.4%) due to active disease despite nonsteroidal anti-inflammatory drugs (± intra-articular corticosteroid) treatment, 59 (31.6%) due to uveitis, 49 (26.2%) due to extended oligoarticular JIA, and 11 (5.9%) due to inflammatory bowel disease. One hundred twenty-three patients (65.8%) achieved remission with DMARDs (Group A), while 64 patients (34.2%) did not respond to DMARD therapy (Group B). In Group B, patients had higher C-reactive protein (CRP) levels as well as higher Juvenile Idiopathic Arthritis Disease Activity Scores-71 (JADAS-71) at diagnosis (both p < 0.001). Moreover, extended oligoarticular JIA subtype (p = 0.017) and involvement of small joints at diagnosis (p = 0.043) were more prevalent among these patients. Group A exhibited a higher frequency of antinuclear antibody positivity (p = 0.014). Elevated CRP levels (> 1.1 mg/dL) (OR 1.308, 95% CI 1.203–3.574; p < 0.001) and high JADAS-71 at diagnosis (> 15.8) (OR 1.659, 95% CI 1.179–2.941; p < 0.001) were associated with DMARD resistance.

Conclusion

Elevated CRP and high JADAS-71 at diagnosis were the main factors associated with DMARD resistance in oligoarticular JIA. Prospective long-term studies may help verify the role of these factors associated with DMARD resistance in oligoarticular JIA.

Key Points

• Conventional DMARDs were most commonly started due to active disease despite NSAID (± intra-articular corticosteroids).

• Remission was achieved with DMARD in 65.8% of oligoarticular JIA patients.

• Elevated CRP and high JADAS-71 at diagnosis were associated with DMARD resistance.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Sihhiye Campus, 06100, Ankara, Turkey

    Seher Sener, Emil Aliyev, Ezgi Deniz Batu, Zeynep Balik, Yagmur Bayindir, Veysel Cam, Ozge Basaran, Yelda Bilginer & Seza Ozen

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  1. Seher Sener
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  2. Emil Aliyev
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Contributions

Conceptualization: Seher Sener and Ezgi Deniz Batu; data curation: Seher Sener and Ezgi Deniz Batu; formal analysis: Seher Sener; investigation: Seher Sener and Ezgi Deniz Batu; methodology: Seher Sener; project administration: Yelda Bilginer and Seza Ozen; resources: Seher Sener, Ezgi Deniz Batu, and Seza Ozen; supervision; Seher Sener, Ezgi Deniz Batu, Emil Aliyev, Zeynep Balik, Yagmur Bayindir, Veysel Cam, and Ozge Basaran; validation: Seher Sener and Ezgi Deniz Batu; visualization; Seher Sener and Ezgi Deniz Batu; roles/writing—original draft: Seher Sener and Ezgi Deniz Batu; and writing—review and editing: Seher Sener, Ezgi Deniz Batu, Emil Aliyev, Zeynep Balik, Yagmur Bayindir, Veysel Cam, Ozge Basaran, Yelda Bilginer, and Seza Ozen.

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Correspondence to Seza Ozen.

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Sener, S., Aliyev, E., Batu, E.D. et al. Factors determining resistance to conventional disease-modifying anti-rheumatic drug treatment in oligoarticular juvenile idiopathic arthritis. Clin Rheumatol 43, 2021–2026 (2024). https://doi.org/10.1007/s10067-024-06925-4

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