Childhood Arthritis: Aggressive Treatment Better?

Nov. 4,  2013 (San Diego) -- Treating children with juvenile arthritis with multiple medications soon after the disease appears is more likely to make symptoms go away than treating them later or with fewer medications at the start, according to new research.

"Remission is achievable if you treat early and aggressively," says study researcher Carol Wallace, MD. She is a pediatric rheumatologist at Seattle Children's Hospital.

She presented the findings at the annual meeting of the American College of Rheumatology.

About 294,000 children under the age of 18 have childhood arthritis and other related conditions, according to the Arthritis Foundation. Juvenile RA is an umbrella term for several types of arthritis. The common thread: chronic, long-term joint inflammation along with fevers, rash, or eye inflammation.

Wallace and her team compared two treatment strategies for a kind of childhood arthritis known as polyarticular JIA. It affects five or more joints soon after the disease appears.

The study included 85 children ages 2 to 17. The researchers focused on which treatment could produce what doctors call ''clinically inactive disease'' within 6 months. For children, that means they have no arthritis, fever, rash, or other symptoms of JIA. After 6 months of no symptoms on JIA medication they are considered in remission.

The children either received:

Wallace followed the children for a year. Among the trends she notes from her research:

Children on the more aggressive therapy with three drugs got to remission a full month earlier than the others.Children in the aggressive group were symptom-free for close to 5 months, about 2 months longer than those on methotrexate alone.Children who received either treatment within 3 months after the disease started had fewer clinic visits compared to those treated later.Children who responded to either treatment within 4 months were more likely to go into remission.

Timothy Beukelman, MD, calls the study “important and impactful.” He is an associate professor of pediatrics in the division of rheumatology at the University of Alabama at Birmingham. He reviewed the findings.

"A clear result from this study is, it's best to treat juvenile arthritis as early as possible," he says. "This study only looked at 1-year outcome. The results may be ongoing."

Wallace's team is continuing to look at results.

Beukelman and Wallace report doing consulting for or receiving research grants from several pharmaceutical companies.

The study was funded by the National Institute for Arthritis and Musculoskeletal and Skin Diseases and the Howe Endowment for Juvenile Idiopathic Arthritis Research.

These findings were presented at a medical conference. They should be considered preliminary, as they have not yet undergone the ''peer review'' process, in which outside experts scrutinize the data prior to publication in a medical journal.

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