Children with juvenile idiopathic arthritis (JIA) and their families have better information that will help them and their doctors decide when to stop treatment, thanks to new research by BC Children's Hospital Investigator and UBC Clinical Associate Professor Dr. Jaime Guzman. Dr. Guzman is the lead author of a study in Annals of the Rheumatic Diseases that shows JIA symptoms often return after the disease has become inactive, but these flares are usually mild.
JIA causes joint pain, swelling and stiffness. These symptoms can severely reduce quality of life and make it difficult for children to play with friends and take part in sports and other physical activities. JIA affects approximately one in 1,000 children. This makes it one of the most common disorders resulting in chronic disability in children and adolescents in Canada.
In previous research, Dr. Guzman and his colleagues found that the typical course of care for JIA is so effective that within two years of diagnosis more than three out of four children no longer had any swollen joints. When a child’s JIA becomes inactive, families and doctors must decide whether or not the child should continue treatment. This can be a difficult choice: If children stop treatment too soon, their symptoms may come back. However, if they continue to take medication, they have an increased risk of experiencing side effects.
Dr. Guzman and his colleagues analyzed data from the Research on Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) cohort study, which followed over one thousand children newly diagnosed with JIA from 2005 to 2010 at all pediatric rheumatology centres in Canada. They found patients have a 42 per cent chance of experiencing a flare within a year of their JIA becoming inactive, but children who manage to successfully stop all treatments only have a 25 per cent chance of needing to re-start treatment in the following year.
Researchers also found that children with certain subtypes of JIA were less likely to experience flares. For example, children with systemic JIA – a type of JIA that causes fevers and rashes in addition to swollen joints – have only a 3 per cent chance of experiencing a flare within a year of discontinuing treatment.
“Our findings show families of children with arthritis need to be prepared for the eventuality of a flare since they are very common,” says Dr. Guzman. “Families can also feel reassured because most flares are mild and usually controlled."
"Perhaps most importantly, families now have better information to rely on when deciding whether to discontinue treatment. They can weigh the very real chance of a flare against low risk of major side effects.”
Dr. Guzman’s work in this study received the Kourir Gold Medal Award from the 2014 Congress of the Pediatric Rheumatology European Society. This honor recognizes the best research that could provide new insights into the treatment of JIA.
Dr. Guzman and his colleagues are now working on ways to calculate the specific probability of a flare for each child who attains inactive disease. They are also trying to determine if a prolonged time on medication actually decreases the chance of a flare. Ultimately, this research will help take the guesswork out of what was once a difficult and painful choice for families.
Jaime Guzman, et al, “The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort” in Annals of the Rheumatic Diseases, May 18, 2015.
Dr. Jaime Guzman (pictured above) is an Investigator and Rheumatologist at BC Children’s Hospital, and a Clinical Associate Professor in the Department of Pediatrics at the University of British Columbia.
Study co-authors include:
Dr. Kimberly Morishita – Investigator and Pediatric Rheumatologist, BC Children’s Hospital; Clinical Assistant Professor, UBC Department of Pediatrics
Dr. David A. Cabral – Investigator and Pediatric Rheumatologist, BC Children’s Hospital; Clinical Professor UBC Department of Pediatrics, Ross Petty-Arthritis Society Research Chair in Pediatric Rheumatology
Dr. Kristin Houghton – Investigator and Pediatric Rheumatologist, BC Children’s Hospital; Clinical Assistant Professor, UBC Department of Pediatrics
Dr. Lori Tucker – Investigator and Pediatric Rheumatologist, BC Children’s Hospital; Clinical Associate Professor, UBC Department of Pediatrics
Dr. Stuart Turvey – Investigator, Director, Clinical Research, and Pediatric Immunologist, BC Children’s Hospital; Aubrey J. Tingle Professor Pediatric Immunology, UBC Department of Pediatrics
Dr. Lori Tucker is also a principal investigator for the ReACCh-Out cohort.
This study was supported by funding from BC Children’s Hospital Foundation, the Canadian Institutes of Health Research and the Fast Foundation.