Methotrexate in Resistant Juvenile Rheumatoid Arthritis

332

195

Methods. In the screening phase, 595 patients who were newly started on a standard dose of MTX were followed up for 6 months. Subsequently, the nonresponders, defined according to the American College of Rheumatology (ACR) pediatric 30% improvement criteria (pediatric 30), were randomized to receive an intermediate dose or higher dose of parenteral MTX for an additional 6 months. Improvement in the screening and randomization phase was defined by the ACR pediatric 30 response, as well as by the 50% and 70% response levels (ACR pediatric 50 and ACR pediatric 70, respectively).Results. In the screening phase, after receiving standard doses of MTX, 430 patients (72%) improved according to the ACR pediatric 30, while 360 (61%) met the ACR pediatric 50 and 225 (38%) met the ACR pediatric 70; among these patients, 69 (12%) also met the definition of complete disease control. Of the 133 nonresponders, 80 were randomized to receive an intermediate dose or higher dose of MTX. In the randomization phase, the ACR pediatric

Section: Baseline Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate

Ruperto

Murray

Gerloni³

et al. 2004

332

195

“…Weekly methotrexate (MTX), at parenteral dosages of up to 15 mg/m 2 /week, has been established as an effective and safe therapy for polyarticular-course JRA (5)(6)(7). For children whose disease does not respond to MTX, anti-tumor necrosis factor (anti-TNF) therapy is a treatment option (8)(9)(10)(11).…”

mentioning

confidence: 99%

A randomized, placebo‐controlled trial of infliximab plus methotrexate for the treatment of polyarticular‐course juvenile rheumatoid arthritis

Ruperto

Lovell

Cuttica

et al. 2007

Self Cite

371

224

Objective. To evaluate the safety and efficacy of infliximab in the treatment of juvenile rheumatoid arthritis (JRA).Methods. This was an international, multicenter, randomized, placebo-controlled, double-blind study. One hundred twenty-two children with persistent polyarticular JRA despite prior methotrexate (MTX) therapy were randomized to receive infliximab or placebo ClinicalTrials.gov identifier: NCT00036374.

“…Since the introduction of more potent treatment strategies, the evaluation of radiographic joint damage has become more prominent in the assessment of disease progression in JIA (2)(3)(4). Because one of the aims of JIA treatment is to prevent or retard joint damage, and radiographs are able to document this damage, a standardized tool for the radiologic evaluation of the lesions of the joints over time is needed.…”

mentioning

confidence: 99%

Development of a standardized method of assessment of radiographs and radiographic change in juvenile idiopathic arthritis: Introduction of the Dijkstra composite score

Rossum¹,

Boers²,

Zwinderman³

et al. 2005

Objective. To evaluate the sensitivity to change of a newly developed radiologic assessment tool, the Dijkstra score, and to develop a numeric composite score and progressor classification scheme to apply in juvenile idiopathic arthritis (JIA) trials.Methods. A placebo-controlled trial of sulfasalazine (SSZ) in patients with oligoarticular-and polyarticular-onset JIA yielded the data for this study. Data were obtained from 418 sets of radiographs of the clinically involved and contralateral joints (at study entry and at 6 months' followup) from 66 JIA patients. The Dijkstra score assesses the presence or absence of swelling, osteopenia, joint space narrowing, growth abnormalities, subchondral bone cysts, erosions, and malalignment. These signs were combined in the Dijkstra composite score, to assess inflammation (DI), growth (DG), and damage (DD). Progression was defined as an increase in either the DG or the DD score. Scores were evaluated among all radiographs, a standard set of films (hand, foot, and knee), and per patient. All scores were used to explore differences between the 2 treatment groups.Results. Over time, 58% of joints remained normal, 23% remained abnormal but stable, 14% showed an increase in signs, and 5% showed a decrease in signs. Of the 66 JIA patients, 12% had normal radiographic findings throughout followup, 27% showed abnormalities at some sites without change, and 61% showed change in at least 1 site. Changes in the DI, DG, and DD scores varied considerably per type of joint and occurred most frequently in joints of the standard set. DI and DG scores changed most often in the knees, while DD scores changed primarily in the hands and feet. The disease course in 8% of joints was classified as progressive. Films of SSZ-treated patients, versus the placebo group, showed less deterioration by the DD scores (P ‫؍‬ 0.04), and the disease course was more often classified as nonprogressive in the SSZ group (P ‫؍‬ 0.037). When progressors were defined as those who had at least one 1 Marion A. J. van Rossum, MD: Emma Children's Hospital AMC and Jan van Breemen Instituut,