SAT0513 THERAPEUTIC APPROACH IN JUVENILE IDIOPATHIC ARTHRITIS: EMPHASIZING PAIN MEDICATION AND NEWLY INITIATED DISEASE MODIFYING ANTIRHEUMATIC DRUGS
Authors: Katariina Rebane, Kristiina Aalto, Maija Haanpää, Kari Puolakka, Lauri Virta, Hannu Kautiainen, Heini Pohjankoski
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Pain relief remains an important aspect in treating patients with juvenile idiopathic arthritis (JIA) despite of the new advanced therapeutic options. Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended providing symptomatic relief in JIA<sup>1</sup>. There is evidence of increased opioid use in adults with rheumatoid arthritis<sup>2</sup>, the use of opioids in children with JIA is poorly studied. <h3>Objectives:</h3> Aim of the study was to describe patterns in using of pain medication and newly initiated antirheumatic drugs in outpatients with JIA. <h3>Methods:</h3> Data on 1507 patients (&lt;16 years) with newly diagnosed JIA from 1 Jan 2010 to 31 Dec 2014 were collected from the register of the Finnish Social Insurance Institution. The index day was the date when reimbursement for JIA medication was admitted. The study period included 12 months pre- and post-index date. All patients were without disease modifying antirheumatic drugs (DMARDs) before the index day. For each patient three age-, gender- and residence-matched controls (altogether 4511) were identified from the National Centre for Population. Drug purchases were assessed in 3-month periods. Co-morbidities were evaluated. <h3>Results:</h3> 20-fold more JIA patients purchased NSAIDs, 10-fold more paracetamol, and 10-fold more opioids (mostly tramadol and codeine) compared to controls. 648 patients (43%) purchased NSAIDs during 0-3 months before and after the index day, and 165 patients (11%) 10-12 months after the index day. 28 patients (2%) purchased opioids 12 months before the index-day, and 14 patients (1%) 12 months after. Paracetamol was purchased by 83 patients (5.1%) and by 59 patients (3.9%), respectively. Methotrexate (n = 1361 (90.3%)) was most commonly prescribed conventional DMARD, followed by prednisolone (n = 368 (24.4%)), hydroxychlorine (n = 194 (12.9%)), sulfasalazine (n = 107 (1.8%)), and biological DMARDs (n = 41 (2.7%)). 26 patients (1.7%) were without antirheumatic treatment at 3-months after index-day. JIA patients had significantly more comorbidities and traumas (p&lt;0.001), and more surgical procedures (p&lt;0.001) compared to controls. <h3>Conclusion:</h3> Purchases of pain medication reduced after DMARDs were started. Only small proportion of JIA patients purchased opioids, despite of having more traumas and surgical procedures. <h3>References</h3> [1] Beukelman T, Patkar NM, Saag KG, et al. 2011American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: Initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res2011; 63:465-482. [2] Zamora-Legoff JA, Achenbach SJ, Crowson CS, Krause ML, Davis JM,3rd, Matteson EL. Opioid use in patients with rheumatoid arthritis 2005-2014: A population-based comparative study. Clin Rheumatol2016;35:1137-1144. <h3>Disclosure of Interests:</h3> None declared