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Disease Recapture Rates After Medication Discontinuation and Flare in Juvenile Idiopathic Arthritis: An Observational Study Within the Childhood Arthritis and Rheumatology Research Alliance Registry.

Publication ,  Journal Article
Ringold, S; Dennos, AC; Kimura, Y; Beukelman, T; Shrader, P; Phillips, TA; Kohlheim, M; Schanberg, LE; Yeung, RSM; Horton, DB ...
Published in: Arthritis Care Res (Hoboken)
April 2023

OBJECTIVE: Children with well-controlled juvenile idiopathic arthritis (JIA) frequently experience flares after medication discontinuation, but the outcomes of these flares have not been well described. The objective of this study was to characterize the rates and predictors of disease recapture among children with JIA who restarted medication to treat disease flare. METHODS: Children with JIA who discontinued conventional synthetic or biologic disease-modifying antirheumatic drugs for well-controlled disease but subsequently experienced a flare and restarted medication were identified from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry. The primary outcome was inactive disease (ID) (physician global assessment <1 and active joint count = 0) 6 months after flare. RESULTS: A total of 333 patients had complete data for ID at 6 months after flare. The recapture rate for the cohort was 55%, ranging from 47% (persistent oligoarthritis) to 69% (systemic arthritis) (P = 0.4). Approximately 67% of children achieved ID by 12 months. In the multivariable model, history and reinitiation of biologic drugs were associated with increased odds of successful recapture (odds ratio [OR] 4.79 [95% confidence interval (95% CI) 1.22-18.78] and OR 2.74 [95% CI 1.62-4.63], respectively). Number of joints with limited range of motion was associated with decreased odds (OR 0.83 per 1 joint increase [95% CI 0.72-0.95]). CONCLUSION: Approximately half of JIA flares post-discontinuation were recaptured within 6 months, but rates of recapture varied across JIA categories. These findings inform shared decision-making for patients, families, and clinicians regarding the risks and benefits of medication discontinuation. Better understanding of biologic predictors of successful recapture in JIA are needed.

Duke Scholars

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Published In

Arthritis Care Res (Hoboken)

DOI

EISSN

2151-4658

Publication Date

April 2023

Volume

75

Issue

4

Start / End Page

715 / 723

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Rheumatology
  • Registries
  • Humans
  • Child
  • Biological Products
  • Arthritis, Juvenile
  • Antirheumatic Agents
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Ringold, S., Dennos, A. C., Kimura, Y., Beukelman, T., Shrader, P., Phillips, T. A., … Childhood Arthritis and Rheumatology Research Alliance Registry Investigators, . (2023). Disease Recapture Rates After Medication Discontinuation and Flare in Juvenile Idiopathic Arthritis: An Observational Study Within the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res (Hoboken), 75(4), 715–723. https://doi.org/10.1002/acr.24994
Ringold, Sarah, Anne C. Dennos, Yukiko Kimura, Timothy Beukelman, Peter Shrader, Thomas A. Phillips, Melanie Kohlheim, et al. “Disease Recapture Rates After Medication Discontinuation and Flare in Juvenile Idiopathic Arthritis: An Observational Study Within the Childhood Arthritis and Rheumatology Research Alliance Registry.Arthritis Care Res (Hoboken) 75, no. 4 (April 2023): 715–23. https://doi.org/10.1002/acr.24994.
Ringold S, Dennos AC, Kimura Y, Beukelman T, Shrader P, Phillips TA, Kohlheim M, Schanberg LE, Yeung RSM, Horton DB, Childhood Arthritis and Rheumatology Research Alliance Registry Investigators. Disease Recapture Rates After Medication Discontinuation and Flare in Juvenile Idiopathic Arthritis: An Observational Study Within the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res (Hoboken). 2023 Apr;75(4):715–723.
Journal cover image

Published In

Arthritis Care Res (Hoboken)

DOI

EISSN

2151-4658

Publication Date

April 2023

Volume

75

Issue

4

Start / End Page

715 / 723

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Rheumatology
  • Registries
  • Humans
  • Child
  • Biological Products
  • Arthritis, Juvenile
  • Antirheumatic Agents
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences