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 .
Trial of early aggressive therapy in polyarticular juvenile idiopathic arthritis.
OBJECTIVE To determine whether aggressive treatment initiated early in the course of rheumatoid factor (RF)-positive or RF-negative polyarticular juvenile idiopathic arthritis ( JIA ) can induce clinical inactive disease within 6 months . METHODS Between May 2007 and October 2010 , a multicenter , prospect i ve , r and omized , double-blind , placebo-controlled trial of 2 aggressive treatments was conducted in 85 children ages 2 - 16 years with polyarticular JIA of < 12 months ' duration . Patients received either methotrexate ( MTX ) 0.5 mg/kg/week ( maximum 40 mg ) subcutaneously , etanercept 0.8 mg/kg/week ( maximum 50 mg ) , and prednisolone 0.5 mg/kg/day ( maximum 60 mg ) tapered to 0 by 17 weeks ( arm 1 ) , or MTX ( same dosage as arm 1 ) , etanercept placebo , and prednisolone placebo ( arm 2 ) . The primary outcome measure was clinical inactive disease at 6 months . An exploratory phase determined the rate of clinical remission on medication ( 6 months of continuous clinical inactive disease ) at 12 months . RESULTS By 6 months , clinical inactive disease had been achieved in 17 ( 40 % ) of 42 patients in arm 1 and 10 ( 23 % ) of 43 patients in arm 2 ( χ(2 ) = 2.91 , P = 0.088 ) . After 12 months , clinical remission on medication was achieved in 9 patients in arm 1 and 3 patients in arm 2 ( P = 0.053 ) . There were no significant interarm differences in adverse events . CONCLUSION Although this study did not meet its primary end point , early aggressive therapy in this cohort of children with recent-onset polyarticular JIA result ed in clinical inactive disease by 6 months and clinical remission on medication within 12 months of treatment in substantial proportions of patients in both arms
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 .