Good disease control , with therapeutic escalation to achieve low disease activity , was recommended .
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis , sacroiliitis , or enthesitis .
Aggressive Combination Drug Therapy in Very Early Polyarticular Juvenile Idiopathic Arthritis (ACUTE–JIA): a multicentre randomised open-label clinical trial
Objectives In juvenile idiopathic arthritis ( JIA ) , the efficacy of very early disease-modifying drug therapy , synthetic or biological , is not well known . Three alternative strategies were compared for treating recent‑onset polyarticular JIA . Methods In a 54-week multicentre open-label clinical trial , 60 disease-modifying antirheumatic drug (DMARD)-naive patients aged 4–15 years were r and omly assigned into three treatment arms . The efficacy of infliximab plus methotrexate ( TNF ) was compared to that of two synthetic therapies : methotrexate alone ( MTX ) and DMARD methotrexate , sulphasalazine and hydroxychloroquine in combination ( COMBO ) . Primary endpoint was American College of Rheumatology paediatric 75 % improvement ( ACR Pedi 75 ) . Secondary endpoints were inactive disease and safety . Results In 59 patients , mean ( ±SE ) age at baseline was 9.6±0.4 years , duration of JIA 1.9±0.2 months and number of active joints 18±1 . ACR Pedi 75 was achieved in 100 % ( 19/19 ) of patients receiving TNF , 65 % ( 13/20 ) on COMBO ( 95 % CI 44 % to 86 % ) and 50 % ( 10/20 ) on methotrexate ( 95 % CI 28 % to 72 % ) p<0.0001 . Thirteen patients receiving TNF ( 68 % ; 95 % CI 47 % to 89 % ) achieved inactive disease , whereas eight ( 40 % ; 95 % CI 22 % to 63 % ) on COMBO and five ( 25 % ; 95 % CI 6 % to 44 % ) on methotrexate did ( p=0.002 ) . Patients on TNF spent a mean 26 weeks ( 95 % CI 18 to 34 ) with inactive disease , longer than did those receiving COMBO ( 13 weeks ; 95 % CI 6 to 20 ) , or methotrexate ( 6 weeks ; 95 % CI 2 to 10 ) . Serious adverse events were rare . Conclusion In early polyarticular JIA , targeting to achieve minimally active or inactive disease , infliximab plus methotrexate was superior to synthetic DMARD in combination and strikingly superior to methotrexate alone
Good disease control , with therapeutic escalation to achieve low disease activity , was recommended .
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis , sacroiliitis , or enthesitis .