Disease-modifying Antirheumatic Drug Use in the Treatment of Juvenile Idiopathic Arthritis: A Cross-sectional Analysis of the CARRA Registry
The Journal of Rheumatology, 08/03/2012

Beukelman T et al. – About three–quarters of all children with juvenile idiopathic arthritis in the Childhood Arthritis and Rheumatology Research Alliance Registry received nonbiologic disease–modifying antirheumatic drug (DMARD). Nearly one–half received biologic DMARD, and their use was strongly associated with rheumatoid factor–positive polyarthritis, psoriatic arthritis, uveitis, and systemic arthritis.

• The authors analyzed cross–sectional baseline enrollment data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from May 2010 through May 2011 for children with JIA.
• Current and prior medication use was included.
• The authors used parsimonious backward stepwise logistic regression models to calculate OR to estimate associations between clinical patient factors and medication use.

• The authors identified 2748 children with JIA with a median disease duration of 3.9 years from 51 US clinical sites.
• Overall, 2023 (74%) had ever received a nonbiologic DMARD and 1246 (45%) had ever received a biologic DMARD.
• Among children without systemic arthritis, methotrexate use was most strongly associated with uveitis (OR 5.2, 95% CI 3.6–7.6), anticitrullinated protein antibodies (OR 4.5, 95% CI 1.7–12), and extended oligoarthritis (OR 4.1, 95% CI 2.5–6.6).
• Among children without systemic arthritis, biologic DMARD use was most strongly associated with rheumatoid factor (RF)–positive polyarthritis (OR 4.3, 95% CI 2.9–6.6), psoriatic arthritis (PsA; OR 3.0, 95% CI 2.0–4.4), and uveitis (OR 2.8, 95% CI 2.1–3.7).
• Among children with systemic arthritis, 160 (65%) ever received a biologic DMARD; tumor necrosis factor inhibitor use was associated with polyarthritis (OR 2.5, 95% CI 3.8–16), while interleukin 1 inhibitor use was not.