Comparison of health-related quality of life in rheumatoid arthritis, psoriatic arthritis and psoriasis and effects of etanercept treatment Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis. Abatacept improves health‐related quality of life, pain, sleep quality, and daily participation in subjects with juvenile idiopathic arthritis The clinical application of etanercept in Chinese patients with rheumatic diseases Efficacy and safety of open-label etanercept on extended oligoarticular juvenile idiopathic arthritis, enthesitis-related arthritis and psoriatic arthritis: part 1 (week 12) of the CLIPPER study Patient-Reported Outcomes and the Association With Clinical Response in Patients With Active Psoriatic Arthritis Treated With Golimumab: Findings Through 2 Years of a Phase III, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Health-Related Quality of Life, Physical Function, Fatigue, and Disease Activity in Children with Established Polyarticular Juvenile Idiopathic Arthritis A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis Self-reported adherence to a home-based exercise program among patients affected by psoriatic arthritis with minimal disease activity. Two-year Efficacy and Safety of Etanercept in Pediatric Patients with Extended Oligoarthritis, Enthesitis-related Arthritis, or Psoriatic Arthritis High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity within and outside the home in patients with axial spondyloarthritis, including nonradiographic axial spondyloarthritis and ankylosing spondylitis Effect of rituximab on physical function and quality of life in patients with rheumatoid arthritis previously untreated with methotrexate Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register The relationship between health-related quality of life, pain, and coping strategies in juvenile arthritis – A one year prospective study Safety of celecoxib and nonselective nonsteroidal anti-inflammatory drugs in juvenile idiopathic arthritis: results of the phase 4 registry Rehabilitation in rheumatoid arthritis: a critical review. An Internet-based Self-management Program with Telephone Support for Adolescents with Arthritis: A Pilot Randomized Controlled Trial Infliximab improves health related quality of life and physical function in patients with psoriatic arthritis Adalimumab improves joint-related and skin-related functional impairment in patients with psoriatic arthritis: patient-reported outcomes of the Adalimumab Effectiveness in Psoriatic Arthritis Trial Pilot study of fitness training and exercise testing in polyarticular childhood arthritis.
Objectives To compare health-related quality of life ( HRQoL ) before and after treatment with etanercept in patients with moderate to severe rheumatoid arthritis ( RA ) , psoriatic arthritis ( PsA ) and psoriasis using spydergram representations . Methods Data from r and omised , controlled trials of etanercept in patients with RA , PsA and psoriasis were analysed . HRQoL was assessed by the medical outcomes survey short form 36 ( SF-36 ) physical ( PCS ) and mental ( MCS ) component summary and domain scores . Baseline comparisons with age and gender-matched norms and treatment-associated changes in domain scores were quantified using spydergrams and the health utility SF-6D measure . Results Mean baseline PCS scores were lower than age and gender-matched norms in patients with RA and PsA , but near normative values in patients with psoriasis ; MCS scores at baseline were near normal in PsA and psoriasis but low in RA . Treatment with etanercept result ed in improvements in PCS and MCS scores as well as individual SF-36 domains across all indications . Mean baseline SF-6D scores were higher in psoriasis than in RA or PsA ; clinical ly meaningful improvements in SF-6D were observed in all three patient population s following treatment with etanercept . Conclusions Patients with RA , PsA and psoriasis demonstrated unique HRQoL profiles at baseline . Treatment with etanercept was associated with improvements in PCS and MCS scores as well as individual domain scores in patients with RA , PsA and psoriasis OBJECTIVES To examine the change in health-related quality of life ( HRQOL ) and its determinants in children with juvenile idiopathic arthritis ( JIA ) treated with methotrexate ( MTX ) .  METHODS Patients were extracted from the PRINTO clinical trial which aim ed to evaluate the efficacy and safety profile of MTX administered in st and ard , intermediate or higher doses ( 10 , 15 and 30 mg/m(2)/week respectively ) . Children with polyarticular-course JIA , who were less than 18 years and had a complete HRQOL assessment were included . RESULTS A total of 521 children were included . At baseline , patients with JIA showed poorer HRQOL ( p<0.01 ) than healthy children . In 207/412 ( 50 % ) and 63 ( 15 % ) children , HRQOL values were 2 st and ard deviations below the mean of healthy controls in the physical and psychosocial summary scale , respectively . After 6 months of treatment with st and ard dose MTX , there was a statistically significant improvement in all HRQOL health concepts , particularly the physical ones . Similar improvements were observed in those who did not respond to a st and ard dose of MTX and were subsequently r and omised to a higher dose . The presence of marked disability at baseline was associated with a fivefold increased risk of retaining poor physical health after 6 months of active treatment with st and ard dose MTX . Other less important determinants of retaining poor physical well-being were the baseline level of systemic inflammation , pain intensity and an antinuclear-antibody-negative status . CONCLUSIONS MTX treatment produces a significant improvement across a wide range of HRQOL components , particularly in the physical domains , in patients with JIA To assess health‐related quality of life ( HRQOL ) in abatacept‐treated children/adolescents with juvenile idiopathic arthritis ( JIA ) Over a 2-year period , to evaluate the efficacy and safety of biologic agents , etanercept ( 25 mg twice per week , s.c . ) was used to treat 57 rheumatoid arthritis ( RA ) patients , 9 ankylosing spondylitis ( AS ) patients , 6 psoriatic arthritis ( PSA ) patients , and 4 juvenile rheumatoid arthritis ( JRA ) patients . In addition to inflammatory arthritis , I have used this tumor necrosis factor ( TNF ) blocker in other rheumatic diseases including idiopathic thrombocytopenic purpura ( ITP ) , Behçet 's disease with intractable oral ulcer , fibromyalgia syndrome , and systemic lupus erythematosis with intractable pleural effusion and acute lumbar disc herniation . For RA , after 6 months of etanercept treatment , all the parameters including number of swollen joints , number of tender joints , disease activity score , erythrocyte sedimentation rate , C-reactive protein , and global health status were rapidly improved ( P < 0.001 or P < 0.0001 ) . The anticyclic citrullinated peptide ( anti-CCP ) antibody and rheumatoid factor also significantly declined . For spondyloarthropathy , it also gave a similar effect as to RA . Both Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index also improved . One of the two cases with Behçet 's disease with intractable oral ulcer had a long-term remission after etanercept . The other Behçet 's disease patient with oral ulcer and another with ITP obtained a good response temporarily . The short-term use of etanercept ( <3 months ) did not bring a significant effect for cases of fibromyalgia syndrome , pleural effusion , and lumbar disc herniation . In conclusion , a dramatic and rapid clinical response in different kinds of arthritis patients can be achieved by etanercept . Moreover , the TNF-α inhibitor also can treat other severe rheumatic-related symptoms . In general , except for a few cases with infection and two cases with malignancy , etanercept was safe in our arthritis patients . We need to study a larger number of patients in order to better underst and the efficacy and safety of etanercept Objective To investigate the efficacy and safety of etanercept ( ETN ) in paediatric subjects with extended oligoarticular juvenile idiopathic arthritis ( eoJIA ) , enthesitis-related arthritis ( ERA ) , or psoriatic arthritis ( PsA ) . Methods CLIPPER is an ongoing , Phase 3b , open-label , multicentre study ; the 12-week ( Part 1 ) data are reported here . Subjects with eoJIA ( 2–17 years ) , ERA ( 12–17 years ) , or PsA ( 12–17 years ) received ETN 0.8 mg/kg once weekly ( maximum 50 mg ) . Primary endpoint was the percentage of subjects achieving JIA American College of Rheumatology ( ACR ) 30 criteria at week 12 ; secondary outcomes included JIA ACR 50/70/90 and inactive disease . Results 122/127 ( 96.1 % ) subjects completed the study ( mean age 11.7 years ) . JIA ACR 30 ( 95 % CI ) was achieved by 88.6 % ( 81.6 % to 93.6 % ) of subjects overall ; 89.7 % ( 78.8 % to 96.1 % ) with eoJIA , 83.3 % ( 67.2 % to 93.6 % ) with ERA and 93.1 % ( 77.2 % to 99.2 % ) with PsA. For eoJIA , ERA , or PsA categories , the ORs of ETN vs the historical placebo data were 26.2 , 15.1 and 40.7 , respectively . Overall JIA ACR 50 , 70 , 90 and inactive disease were achieved by 81.1 , 61.5 , 29.8 and 12.1 % , respectively . Treatment-emergent adverse events ( AEs ) , infections , and serious AEs , were reported in 45 ( 35.4 % ) , 58 ( 45.7 % ) , and 4 ( 3.1 % ) , subjects , respectively . Serious AEs were one case each of abdominal pain , bronchopneumonia , gastroenteritis and pyelocystitis . One subject reported herpes zoster and another varicella . No differences in safety were observed across the JIA categories . Conclusions ETN treatment for 12 weeks was effective and well tolerated in paediatric subjects with eoJIA , ERA and PsA , with no unexpected safety findings To evaluate the effect of golimumab on physical function , health‐related quality of life ( HRQOL ) , and productivity in psoriatic arthritis ( PsA ) Objective . To compare child  self-report and parent/proxy report of health-related quality of life ( HRQOL ) , disability , and fatigue in children with active polyarticular juvenile idiopathic arthritis ( JIA ) to that of children with inactive polyarticular JIA and to previous data from healthy controls . Methods . Cross-sectional survey of children with polyarticular JIA diagnosed and treated between 2000 to 2006 and their parent/proxy . The Childhood Health Assessment Question naire , Pediatric Quality of Life Inventory ( PedsQL ) Generic Core Scales , PedsQL Rheumatology Module , and PedsQL Multidimensional Fatigue Scale were administered . Disease activity data were collected from the physician clinic notes . Comparisons were performed with t tests . Correlations between patient and parent/proxy reports were measured with Pearson correlation coefficients . Results . Sixty children and /or their parents/proxies participated ( 79 % response rate ) . Disease activity status was available for 52 , and 32 met criteria for inactive disease ( 62 % ) . Participants reported lower scores on the PedsQL Generic Core Scales ( range 2.54–9.13 points lower ) and the PedsQL Rheumatology Module ( range 2.46–6.96 points lower ) than those with inactive disease . Participants also reported lower scores on the PedsQL Multidimensional Fatigue Scale than did healthy controls , regardless of disease activity status ( range 0.06–9.2 points lower ) . Conclusion . Although children in this cohort with polyarticular JIA and inactive disease reported HRQOL scores similar to those of healthy controls , children with polyarticular JIA and their parents/proxies tended to report more fatigue than controls , regardless of disease activity . Application of these measures prospect ively to larger cohorts of children with JIA is needed to assess these differences Objective To determine the effectiveness of a patient-initiated disease-modifying antirheumatic drugs ( DMARD ) self-monitoring service for people with rheumatoid ( RA ) or psoriatic arthritis ( PsA ) on methotrexate .  Methods A two-arm , single-centre , r and omised controlled trial assessing superiority in relation to healthcare use , clinical and psychosocial outcomes . Participants were 100 adults with either RA or PsA on a stable dose of methotrexate , r and omly assigned to usual care or the patient-initiated service .  Intervention participants were trained how to underst and and interpret their blood tests and use this information to initiate care from their clinical nurse specialist ( CNS ) . The primary outcome was the number of outpatient visits to the CNS during the trial period . Differences between groups were analysed using Poisson regression models . Secondary outcomes were collected at baseline and after the third and sixth blood tests . Disease activity was measured using either the Disease Activity Score in 28 joints or Psoriatic Arthritis Response Criteria ( PsARC ) , pain and fatigue using a visual numeric scale and the Health Assessment Question -II , Hospital Anxiety and Depression Scale and SF12 were completed to assess disability , mood and quality of life , respectively . Differences between groups over time on secondary outcomes were analysed using multilevel models . Results The patient-initiated DMARD self-monitoring service was associated with 54.55 % fewer visits to the CNS ( p<0.0001 ) , 6.80 % fewer visits to the rheumatologist ( p=0.23 ) and 38.80 % fewer visits to the general practitioner ( p=0.07 ) , compared with control participants . There was no association between trial arm and any of the clinical or psychosocial outcomes . Conclusions The results suggest that a patient-initiated service that incorporates patients ’ self-monitoring DMARD therapy can lead to significant reductions in healthcare use , while maintaining clinical and psychosocial well-being . Trial registration number IS RCT N21613721 Our aim is to assess the prevalence and associated clinical features of  anti-CCP ( cyclic citrullinated peptide )  antibodies for RF ( rheumatoid factor)-positive and RF-negative rheumatoid arthritis ( RA ) and psoriatic arthritis ( PsA ) . In a prospect i ve , cross-sectional , multi-centre study , we determined the titres of anti-CCP antibodies in 208 RA patients ( 129 RF-positive , 79 RF-negative ) , 56 PsA patients and 39 healthy controls ( HC ) . Clinical parameters including disease activity ( disease activity score 28—DAS28 ) , physical disability ( health assessment question naire — HAQ ) , functional capacity ( functional class ) and radiological erosions were investigated in patients with RA . In PsA patients , clinical and radiological features were determined . Anti-CCP2 antibodies were measured using a second-generation anti-CCP enzyme-linked immunosorbent assay ( Euro-Diagnostica , Netherl and s ) . One-hundred four of 129 RF-positive RA ( 81 % ) , 16 of 79 RF-negative RA ( 20 % ) , seven of 56 PsA patients ( 12.5 % ) and none of the HC had anti-CCP antibodies . RA patients with anti-CCP antibodies had significantly higher disease activity , greater loss of function and more frequent erosive disease than anti-CCP antibody-negative group . In subgroup analysis , anti-CCP antibodies in RF-negative patients were also associated with erosive disease . All PsA patients with anti-CCP antibodies had symmetric arthritis with higher number of swollen joints . The prevalence of anti-CCP antibodies in RF-positive RA patients was significantly higher than in RF-negative RA and PsA patients . Anti-CCP antibodies were also associated with erosive disease in RF-negative RA patients . Both anti-CCP and RF tests were negative in 30 % of the patients . Anti-CCP positivity was a frequent finding in PsA and associated with symmetrical polyarthritis Objectives To compare the prevalence , clinical and radiographic characteristics of  psoriatic spondyloarthritis ( PsSpA ) in psoriatic arthritis ( PsA ) , with ankylosing spondylitis ( AS ) . Methods A prospect i ve single-centre cross-sectional observational study recruited consecutive PsA and AS cases . Participants completed outcome measures , and underwent clinical examination , axial radiographic scoring and HLA-sequencing . Multivariable analyses are presented . Results The 402 enrolled cases ( 201 PsA , 201 AS ; fulfilling classification criteria for respective conditions ) were reclassified based upon radiographic axial disease and psoriasis , as : 118 PsSpA , 127 peripheral-only PsA ( pPsA ) , and 157 AS without psoriasis ( AS ) cases . A significant proportion of patients with radiographic axial disease had PsSpA ( 118/275 ; 42.91 % ) , and often had symptomatically silent axial disease ( 30/118 ; 25.42 % ) . Modified New York criteria for AS were fulfilled by 48/201 ( 23.88 % ) PsA cases , and Classification of Psoriatic Arthritis criteria by 49/201 ( 24.38 % ) AS cases . pPsA compared with PsSpA cases had a lower frequency of HLA-B*27 ( OR 0.12 ; 95 % CI 0.05 to 0.25 ) . Disease activity , metrology and disability were comparable in PsSpA and AS . A significant proportion of PsSpA cases had spondylitis without sacroiliitis ( 39/118 ; 33.05 % ) ; they less frequently carried HLA-B*27 ( OR 0.11 ; 95 % CI 0.04 to 0.33 ) . Sacroiliac joint complete ankylosis ( adjusted OR , ORadj 2.96 ; 95 % CI 1.42 to 6.15 ) and bridging syndesmophytes ( ORadj 2.78 ; 95 % CI 1.49 to 5.18 ) were more likely in AS than PsSpA. Radiographic axial disease was more severe in AS than PsSpA ( Psoriatic Arthritis Spondylitis Radiology Index Score : adjusted incidence risk ratio 1.13 ; 95 % CI 1.09 to 1.19 ) . Conclusions In a combined cohort of patients with either PsA or AS from a single centre , 24 % fulfilled classification criteria for both conditions . The pattern of axial disease was influenced significantly by the presence of skin psoriasis and HLA-B*27 More than half of all patients with psoriatic arthritis ( PsA ) exhibit progressive erosive arthritis , associated with severe functional impairment and psychosocial disability .  Biologics have been suggested to be more effective in inducing minimal disease activity " ( MDA ) than disease-modifying antirheumatic drugs ( DMARDs ) . Behavioral patient education appears to be more effective in encouraging patients to increase their physical activity ( PA ) levels . The aim of the study was to evaluate the benefits of home-based exercises program on disease activity and quality of life in MDA-PsA patients treated with an anti-tumor necrosis factor ( TNF ) and DMARD therapy .  We observed a self-reported adherence rate to home-based exercise of 76.6 % and data showed the impact of the exercise program on self-reported health and mental assessment . A positive relationship between patient and therapist is crucial , influencing the quality of the performance , the emotional support , and increasing motivation in PsA patients Objective . The main objective was to determine the 2-year clinical benefit and safety of  etanercept ( ETN ) in children with the juvenile idiopathic arthritis ( JIA ) categories of extended oligoarthritis ( eoJIA ) , enthesitis-related arthritis ( ERA ) , or psoriatic arthritis ( PsA ) . Methods . CLIPPER was a 96-week , phase IIIb , open-label , multicenter study . Patients with eoJIA , ERA , or PsA received ETN 0.8 mg/kg once weekly ( 50 mg max ) for up to 96 weeks . The proportions of patients reaching the JIA American College of Rheumatology ( ACR ) 30/50/70/90/100 and inactive disease responses at Week 96 were calculated . Adverse events ( AE ) were collected throughout the study ( intention-to-treat sample ) . Results . There were 127 patients ( eoJIA n = 60 , ERA n = 38 , PsA n = 29 ) who received ≥ 1 dose of ETN .  The mean disease duration was 31.6 ( eoJIA ) , 23.0 ( ERA ) , and 21.8 ( PsA ) months . At Week 96 , JIA ACR 30/50/70/90/100/inactive disease responses ( 95 % CI ) were achieved by 84.3 % ( 76.7 , 90.1 ) , 83.5 % ( 75.8 , 89.5 ) , 78.7 % ( 70.6 , 85.5 ) , 55.1 % ( 46.0 , 63.9 ) , 45.7 % ( 36.8 , 54.7 ) , and 27.6 % ( 20.0 , 36.2 ) of patients , respectively . The most common AE ( no. events , events per 100 patient-yrs ) overall were headache ( 23 , 10.7 ) , pyrexia ( 12 , 5.6 ) , and diarrhea ( 10 , 4.6 ) . The most common infections were upper respiratory tract infection ( 83 , 38.6 ) , pharyngitis ( 50 , 23.2 ) , gastroenteritis ( 22 , 10.2 ) , bronchitis ( 19 , 8.8 ) , and rhinitis ( 17 , 7.9 ) . No cases of malignancy , active tuberculosis , demyelinating disorders , or death were reported . Conclusion . Over 96 weeks of therapy , ETN demonstrated sustained efficacy at treating the clinical symptoms of all 3 JIA categories , with no major safety issues OBJECTIVE To determine the prevalence of temporom and ibular joint ( TMJ ) disease in a cohort of children with new-onset juvenile idiopathic arthritis ( JIA ) , and to compare magnetic resonance imaging ( MRI ) with ultrasound ( US ) for the detection of acute and chronic changes of TMJ arthritis . METHODS Between January 2005 and April 2007 , children with newly diagnosed JIA were prospect ively evaluated for TMJ arthritis . Prior to imaging , jaw pain and disability were assessed with question naires and physical examination . The TMJs of all patients were imaged with MRI and US within 8 weeks of diagnosis . RESULTS Of the 32 patients enrolled , 78 % were female , and the median age was 8.6 years ( range 1.5 - 17.2 years ) .  Acute TMJ arthritis was diagnosed in 75 % of the children by MRI and in none by US ; chronic arthritis was diagnosed in 69 % by MRI and in 28 % by US . Findings of both acute and chronic TMJ disease were detected by MRI in 53 % of the patients . Of those with acute TMJ arthritis , 71 % were asymptomatic , and 63 % had normal findings on jaw examination . Fifty-six percent of patients with acute disease had an improved maximal incisal opening after corticosteroid injection . Among these responders , 56 % had been asymptomatic and had normal jaw examination findings . CONCLUSION TMJ arthritis was present in the majority of patients with new-onset JIA . Findings on MRI along with responses to treatment among asymptomatic patients with normal jaw examination findings suggest that a history review and physical examination are not sufficient to screen for TMJ disease . Our results also suggest that MRI and US findings are not well correlated , and that MRI is preferable for the detection of TMJ disease in new-onset JIA Introduction The arthritis-specific Work Productivity Survey ( WPS ) was developed to evaluate productivity limitations associated with arthritis within and outside the home . There is an unmet need for an instrument assessing similar productivity limitations in axial spondyloarthritis ( axSpA ) , including nonradiographic axSpA and ankylosing spondylitis . Following its validation in rheumatoid and psoriatic arthritis , we aim ed to assess psychometric properties of WPS in adult-onset active axSpA in this analysis . Methods Psychometric properties were assessed using data from the RAPID-axSpA trial ( NCT01087762 ) in which research ers investigated certolizumab pegol efficacy and safety in axSpA. WPS was completed at baseline and every 4 weeks until week 24 . Validity was evaluated at study baseline via known-groups defined by the first and third quartile cutoffs of patient scores to Ankylosing Spondylitis Disease Activity Score ( ASDAS ) , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , back pain , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Short Form 36 health survey ( SF-36 ) and Ankylosing Spondylitis Quality of Life Scale ( ASQoL ) . Responsiveness and reliability were assessed by comparing WPS mean changes in ASAS 20 % improvement criteria ( ASAS20 ) , BASDAI50 , ASDAS clinical ly important improvement/major improvement ( CII/MI ) and BASFI minimum clinical ly important difference ( MCID ) responders versus nonresponders at week 12 . All comparisons were conducted on observed cases in the r and omized set using a nonparametric bootstrap-t method . Results The results confirmed the psychometric properties of WPS . AxSpA patients with a worse health state had significantly more days of household work lost , household work with reduced productivity , social activities missed and outside help hired , as well as a higher interference rate of arthritis , than patients with a better health state . Similarly , employed patients with a worse health state had significantly more work days lost or with productivity reduced , and a higher interference of arthritis on work productivity . Similar findings were also observed in the nonradiographic ( nr ) axSpA and AS sub population s. The WPS was responsive to clinical changes , with responders reporting larger improvements at week 12 in WPS scores versus nonresponders . Effect sizes in responders were generally moderate to large ( st and ardized response mean > 0.5 ) . Conclusions These analyses demonstrate that WPS is a valid , responsive and reliable instrument for the measurement of productivity within and outside the home in adult-onset axSpA , as well as the in sub population s of AS and To assess the effect of rituximab plus methotrexate ( MTX ) compared with MTX alone on patient‐reported outcomes ( PROs ) and health‐related quality of life ( HRQOL ) in patients with active early rheumatoid arthritis ( RA ) previously untreated with MTX Background Treatment of  juvenile idiopathic arthritis ( JIA ) has changed dramatically since the introduction of biological agents in 1999 . Objective To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA . Methods The Arthritis and Biologics in Children register ( multicentre prospect i ve observational study ) aim ed to include all consecutive patients with JIA in the Netherl and s who had started biological agents since 1999 . Patients were divided according to year of introduction of first biological agent . Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years . Results 335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010 . Etanercept remained the most often prescribed biological agent for non-systemic JIA ; anakinra became first choice for systemic JIA . The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased . During these 12 years of observation , biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS ( Juvenile Arthritis Disease Activity Score ) disease activity . All baseline disease activity parameters were lowered in patients with non-systemic JIA . In systemic JIA , prescription patterns changed towards very early introduction of biological agents ( median 0.4 years of disease duration ) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates . These changes for both systemic and non-systemic JIA result ed in more patients with inactive disease after 3 and 15 months of treatment . Conclusions Biological agents are increasingly prescribed , earlier in the disease and in patients with JIA with lower disease activity . These changes are accompanied by better short-term disease outcomes The aim of this 12-month prospect i ve study was to compare reports describing the health-related quality of life ( HRQL ) of children with Juvenile idiopathic arthritis ( JIA ) obtained from parents and children , to investigate the extent to which the children ’s HRQL changed over a 12-month period , and to describe the relationship between children ’s HRQL , and their experience of pain and use of pain coping strategies . Fifty-four children aged 8–18 years with JIA and their parents completed st and ard question naires assessing children ’s HRQL , pain intensity , and pain coping strategies at baseline , 6 months , and 12 months . In general , children reported that their HRQL was better than was reported by parents . Both informants described children ’s HRQL as being very stable over the 12 months of the study . Consistent with the Biobehavioural Model of Pain , there was a significant negative relationship between children ’s HRQL and their experience of pain . However , there was little evidence that pain coping strategies mediated the relationship between children ’s experience of pain and their HRQL Background This study aim ed to assess long-term safety and developmental data on juvenile idiopathic arthritis ( JIA ) patients treated in routine clinical practice with celecoxib or nonselective nonsteroidal anti-inflammatory drugs ( nsNSAIDs ) .  Methods Children aged ≥2 to < 18 years with rheumatoid-factor – positive or –negative polyarthritis , persistent or extended oligoarthritis , or systemic arthritis were enrolled into this prospect i ve , observational , multicenter st and ard-of-care registry . Eligible patients were newly or recently prescribed ( ≤6 months ) an nsNSAID or celecoxib .  Enrolled patients were followed to the end of the study , whether they remained on the original NSAID , switched , or discontinued therapy altogether . All adverse events ( AEs ) regardless of severity were captured in the data base . Results A total of 274 patients ( nsNSAID , n = 219 ; celecoxib , n = 55 ) were observed for 410 patient-years of observation . Naproxen , meloxicam , and nabumetone were the most frequently used nsNSAIDs . At baseline , the celecoxib group was older , had a numerically longer median time since diagnosis , and a numerically higher proportion of patients with a history of gastrointestinal-related NSAID intolerance . AEs reported were those frequently observed with NSAID treatment and were similar across groups ( nsNSAIDs : 52.0 % ; celecoxib : 52.9 % ) . Twelve unique patients experienced a total of 18 serious AEs ; the most frequent were infections , and none was attributed to NSAID use . Conclusions The safety profile of celecoxib and nsNSAIDs appears similar overall . The results from this registry , ongoing pharmacovigilance , and the phase 3 trial that led to the approval of celecoxib for children with JIA provide evidence that the benefit-risk for celecoxib treatment in JIA remains positive . Trial registration Clinical Trials.gov identifier NCT00688545 This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes Objective . To determine the feasibility of a 12-week Internet-based self-management program of disease-specific information , self-management strategies , and social support with telephone support for youth with juvenile idiopathic arthritis ( JIA ) and their parents , aim ed at reducing physical and emotional symptoms and improving health-related quality of life ( HRQOL ) . Methods . A nonblind pilot r and omized controlled trial ( NCT01011179 ) was conducted to test the feasibility of the “ Teens Taking Charge : Managing Arthritis Online ” Internet intervention  across 4 tertiary-level centers in Canada . Participants were 46 adolescents with JIA , ages 12 to 18 years , and 1 parent for each participant , who were r and omized to the control arm ( n = 24 ) or the Internet intervention ( n = 22 ) . Results . The 2 groups were comparable on demographic and disease-related variables and treatment expectation at baseline . Attrition rates were 18.1 % and 20.8 % , respectively , from experimental and control groups . Ninety-one percent of participants r and omized to the experimental group completed all 12 online modules and weekly phone calls with a coach in an average of 14.7 weeks ( SD 2.1 ) . The control group completed 90 % of weekly attention-control phone calls . The Internet treatment was rated as acceptable by all youth and their parents . In posttreatment the experimental group had significantly higher knowledge ( p < 0.001 , effect size 1.32 ) and lower average weekly pain intensity ( p = 0.03 , effect size 0.78 ) . There were no significant group differences in HRQOL , self-efficacy , adherence , and stress posttreatment . Conclusion . Findings support the feasibility ( acceptability , compliance , and user satisfaction ) and initial efficacy of Internet delivery of a self-management program for improving disease-specific knowledge and reducing pain in youth with JIA Objectives : To evaluate the effect of infliximab on health related quality of life ( HRQoL ) and physical function in patients with active psoriatic arthritis ( PsA ) in the IMPACT 2 trial . Methods : 200 patients with PsA unresponsive to conventional treatment were r and omised to intravenous infusions of infliximab 5 mg/kg or placebo at weeks 0 , 2 , 6 , 14 , and 22 ; patients with inadequate response entered early escape at week 16 .  HRQoL was assessed using the Short Form-36 ( SF-36 ) at weeks 0 , 14 , and 24 . Functional disability was assessed using the Health Assessment Question naire ( HAQ ) at every visit through week 24 . Associations between changes in quality of life ( SF-36 ) and articular ( American College of Rheumatology ( ACR ) ) and dermatological ( Psoriasis Area and Severity Index ( PASI ) ) responses were examined . Results : Mean percentage improvement from baseline in HAQ was 48.6 % in the infliximab group compared with worsening of 18.4 % in the placebo group at week 14 ( p<0.001 ) . Furthermore , 58.6 % and 19.4 % of infliximab and placebo treated patients , respectively , achieved a clinical ly meaningful improvement in HAQ ( that is , ⩾0.3 unit decrease ) at week 14 ( p<0.001 ) . Increases in physical and mental component summary ( PCS and MCS ) scores and all eight scales of the SF-36 in the infliximab group were greater than those in the placebo group at week 14 ( p⩽0.001 ) . These benefits were sustained through week 24 . Patients achieving ACR20 and PASI75 responses had the greatest improvements in PCS and MCS scores . Conclusions : In patients with PsA  , infliximab 5 mg/kg significantly improved HRQoL and physical function compared with placebo through 24 weeks Objective : To evaluate the effects of adalimumab on patient-reported outcomes of joint-related and skin-related functional impairment , health-related quality of life , fatigue and pain in patients with psoriatic arthritis ( PsA ) . Methods : Patients with moderately- to severely- active PsA were treated with adalimumab , 40 mg , every other week , or placebo , in this 24-week , r and omised , controlled trial . Patient-reported outcomes included the Health Assessment Question naire Disability Index ( HAQ DI ) , Short-Form 36 Health Survey ( SF-36 ) , the Functional Assessment of Chronic Illness Therapy — Fatigue ( FACIT-Fatigue ) Scale and the Dermatology Life Quality Index ( DLQI ) . Results : Adalimumab ( n = 151 ) and placebo ( n = 162 ) groups were comparable with respect to baseline demographics and disease severity . Significant changes from baseline in HAQ DI were reported for adalimumab v placebo ( −0.4 v −0.1 , p<0.001 ) at both 12 and 24 weeks . At week 24 , significant improvements in the SF-36 domains of physical functioning , role-physical , bodily pain , general health , vitality and social functioning , as well as the physical component summary score , were observed for adalimumab versus placebo ( p<0.01 ) . These reported changes in HAQ DI and SF-36 were also clinical ly important . Significantly more patients treated with adalimumab had complete resolution of functional loss ( HAQ DI = 0 ) and dermatological-related functional limitations ( DLQI = 0 ) compared with placebo at weeks 12 and 24 ( p⩽0.001 ) . Adalimumab led to significantly greater improvements in FACIT-Fatigue scores , pain scores , and disease activity measures versus placebo at 12 and 24 weeks ( p<0.001 for all ) . Conclusions : Adalimumab improved physical-related and dermatological-related functional limitations , HRQOL , fatigue and pain in patients with PsA treated for 24 weeks OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs
There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS
The aim of this systematic review was to evaluate the evidence from r and omised controlled trials ( RCTs ) evaluating the effectiveness of interactive digital interventions ( IDIs ) for physical activity ( PA )  and  health related quality of life ( HRQoL )  in people with Inflammatory Arthritis [ rheumatoid arthritis ( RA ) , juvenile idiopathic arthritis ( JIA ) axial Spondyloarthritis ( AS ) and psoriatic arthritis ( PsA ) ] .