AI Summary & Key Takeaways
AI InsightThe age at diagnosis (HR=1.12; p=0.247); gender (HR=2.53; p=0.210); family history of ankylosing spondylitis (HR=1.17; p=0.730); inflammatory back pain (HR=0.57; p=0.175); the shoulder (HR=0.75 p=0.706), hip (HR=0.45; p=0.129), and small-joint involvement (HR=1.53; p=0.439);sacroiliitis with physical examination (HR=0.90; p=0.814) and magnetic resonance imaging (MRI)(HR=2.84; p=0.110); enthesitis (HR=0.83; p=0.670); presence of uveitis (HR=2.04; p=0.342); presenceof HLA-B27 (HR=1.39; p=0.524); initial high acute phase reactants levels(HR=1.89; p=0.183); initialJSpADA score (HR=0.98; p=0.944); and last JADI-A (HR=1.41; p=0.060) score did not affect the duration of DMARDs treatment before switching to biological treatments.Conclusion: In our study, the absence of factors affecting the duration of DMARDs application inpatients with ERA showed that DMARDs may still be applied as the first line of treatment.
📌 3 Key Takeaways
Abstract
Objective: Treatments for enthesitis-related arthritis (ERA) consist of a mono- or combination therapy with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs (DMARDs),and biological agents, and they are primarily based on adult studies and studies on other forms ofjuvenile idiopathic arthritis, depending on whether there is axial or peripheral involvement. We useDMARDs frequently in our daily practice, even in patients with axial involvement. The main reasonfor this is that the health insurance system in Turkey does not allow the use of Tumor NegrosisFactor (TNF) blockers as the first line of treatment. The aim of this study is to evaluate the factorsaffecting the duration of DMARDs application in patients with ERA.Methods: Fifty-two patients with ERA were accepted in this retrospective cohort study. These patients did not have an inflammatory bowel disease, reactive arthritis or undifferentiated arthritis,psoriasis, and familial Mediterranean fever. Demographic characteristics, medical history, the initialand follow-up physical examination, initial Juvenile Spondyloarthritis Disease Activity Index (JSpADA), initial laboratory tests, radiographic tests, Juvenile Arthritis Damage Index-articulary (JADI-A)and extra-articulary (JADI-E) on the last admission, and data on medical treatments were recordedfrom the registered data. The univariate Cox proportional hazards regression analyses was used todetermine factors affecting the non-response time of ERA patients to DMARDs before the biological treatment was started.Results: Twenty-seven patients (52%) achieved remission with DMARDs, while 25 (48%) patientsdid not. The age at diagnosis (HR=1.12; p=0.247); gender (HR=2.53; p=0.210); family history of ankylosing spondylitis (HR=1.17; p=0.730); inflammatory back pain (HR=0.57; p=0.175); the shoulder (HR=0.75 p=0.706), hip (HR=0.45; p=0.129), and small-joint involvement (HR=1.53; p=0.439);sacroiliitis with physical examination (HR=0.90; p=0.814) and magnetic resonance imaging (MRI)(HR=2.84; p=0.110); enthesitis (HR=0.83; p=0.670); presence of uveitis (HR=2.04; p=0.342); presenceof HLA-B27 (HR=1.39; p=0.524); initial high acute phase reactants levels(HR=1.89; p=0.183); initialJSpADA score (HR=0.98; p=0.944); and last JADI-A (HR=1.41; p=0.060) score did not affect the duration of DMARDs treatment before switching to biological treatments.Conclusion: In our study, the absence of factors affecting the duration of DMARDs application inpatients with ERA showed that DMARDs may still be applied as the first line of treatment.