Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

作者：Timothy Hahn, Carrie Daymont, Timothy Beukelman, Brandt Groh, Kimberly A. Hays, Catherine A. Bingham, Lisabeth V. Scalzi, for the CARRA Registry investigators, N. Abel, Khalid Abulaban, Alyce S. Adams, Matthew Adams, R. Agbayani, J. Aiello, Shoghik Akoghlanian, C. Alejandro, E. Allenspach, Risa Alperin, M. Alpizar, Gil Amarilyo, William G Ambler, E. L. Anderson, Stacy P. Ardoin, S. Armendariz, Emma H. Baker, Imelda Balboni, Stephen J. Balevic, L. Ballenger, S. Ballinger, Nayimisha Balmuri, Fatima Barbar‐Smiley, L. Barillas-Arias, Matthew L. Basiaga, Kevin Baszis, Mara L. Becker, H. Bell-Brunson, E. Beltz, Heather Benham, Susanne M. Benseler, William Bernal, Timothy Beukelman, T. Bigley, Bryce A. Binstadt, C. Black, M. Blakley, John F. Bohnsack, J. Boland, Alexis Boneparth, Simon Bowman, Claudia Bracaglia, Elizabeth B. Brooks, M. Brothers, A. G. P. Brown, Hermine I. Brunner, M. Buckley, M. Buckley, Hülya Bükülmez, Danielle R. Bullock, Bonnie Cameron, Scott Canna, Laura Cannon, P. Carper, V. Cartwright, Elaine Cassidy, L. Cerracchio, E. Chalom, Joyce C. Chang, A. Chang-Hoftman, V. Chauhan, Peter Chira, T. Chinn, K. Chundru, H. Clairman, Dominic O. Co, A. Confair, H. Conlon, R. Connor, Ashley M. Cooper, Jennifer C. Cooper, Sara Cooper, C. Correll, R. Corvalan, D. Costanzo, Randy Q. Cron, L. Curiel-Duran, T. Curington, M. Curry, Austin Dalrymple, Alaina M. Davis, Christopher Davis, Christopher Davis, T. Davis, Fabrizio De Benedetti, Deirdre De Ranieri, Jay B. Dean, Fatma Dedeoğlu, Marietta DeGuzman, N. Delnay, V. Dempsey, E. DeSantis, T. Dickson, J. Dingle, Brittany Donaldson, E. Dorsey, Saunya Dover, J. Dowling, J. Drew, K. Driest, Qing Du, K. Duarte, D. Durkee, E. Duverger, Jeffrey Dvergsten, A. Eberhard, M. Eckert, Kaleo Ede, Barbara Edelheit, Cuoghi Edens, C. Edens, Y. Edgerly, M. Elder, B. Ervin, S. Fadrhonc, C. Failing, Danielle C. Fair, M. Falcon, Leslie Favier, S. Federici, Brian M. Feldman, J. Fennell, Ian Ferguson, Polly J. Ferguson, BIA ALMEIDA FERREIRA, R. Ferrucho, Kara G. Fields, Terri H. Finkel, Meghann M. Fitzgerald, C. Fleming, O. Flynn, L. Fogel, Emily Fox, Megan E. Fox, L. Franco, M. A. R. Freeman, K. Fritz, D. Sean Froese, Robert C. Fuhlbrigge, J. Fuller, Nancy George, Kerstin Gerhold, Dana Gerstbacher, Mileka Gilbert, Miriah Gillispie‐Taylor, E. Giverc, C. Godiwala, Y. Ingrid Goh, Haseeb Goheer, Donald P. Goldsmith, E. Gotschlich, Alisa Gotte, Beth S. Gottlieb, C. Gracia, T. Brent Graham, Sriharsha Grevich, T A Griffin, J. Griswold, Alexei A. Grom, M. Guevara, P. Guittar, Marietta De Guzman, Marlene Hager, Timothy Hahn, Olha Halyabar, E. Hammelev, M. Hance, A. Hanson, Liora Harel, S. Haro, Julia G. Harris, Onengiya Harry, E. Hartigan, Jonathan S. Hausmann, Arielle Hay, Kristen Hayward, J. Heiart, K. Hekl, L Henderson, Michael Henrickson, Aimee O. Hersh, K. Hickey, P. Hill, S. Hillyer, Linda T. Hiraki, M. Hiskey, Patricia M. Hobday, C. Hoffart, M. Holland, M. Hollander, Seungkwan Hong, M. Horwitz, Joyce Hsu, Adam M. Huber, Jennifer Huggins, Joyce Hui‐Yuen, Chien‐Hui Hung, J. Huntington, Anna Huttenlocher, Maria Ibarra, Lisa F. Imundo, C. Inman, Antonella Insalaco, Annette M. Jackson, Shaun W. Jackson, Karen James, Ginger Janow, J. Jaquith, S. Jared, Nicole Johnson, J. Jones, J. Jones, Jordan T. Jones, Karla Jones, Susan Jones, S. Joshi, Lawrence Jung, C. Justice, A. Justiniano, N. Karan, Katherine Kaufman, A. Kemp, Elizabeth A. Kessler, U. Khalsa, Bernadette Kienzle, S. Kim, Yukiko Kimura, D. Kingsbury, Maleewan Kitcharoensakkul, T. Klausmeier, K. E. Klein, Marisa Klein‐Gitelman, Breanna Kompelien, A. Kosikowski, Leonard K. Kovalick, J. Kracker, S. Kramer, C. Kremer, Jennifer C. Lai, J. Lam, Bianca Lang, Sivia Lapidus, B. Lapin, A. Lasky, D. Latham, Erica Lawson, Ronald M. Laxer, P. Lee, P. Lee, T. Lee, Logan Lentini, Melissa A. Lerman, Deborah M. Levy, S. Li, S. Lieberman, L. Lim, Chun‐Ying Lin, Nicholas Ling, M. Lingis, Mindy S. Lo, Dan Lovell, D. Lowman, Nadia Luca, S. Lvovich, Casey Madison, Jacqueline A. Madison, S. Magni Manzoni, Bashir Ahmad Malla, J. Maller, Michael A. Malloy, Melissa L. Mannion, C. Manos, L. Marques, A. Martyniuk, Thomas G. Mason, S. Mathus, Lindy McAllister, Katherine McCarthy, K. John McConnell, Elle McCormick, Deborah McCurdy, P. Mc Curdy Stokes, Sarayna S. McGuire, I. McHale, A. McMonagle, C. McMullen-Jackson, Esra Meidan, Elizabeth Mellins, E. Mendoza, R. Mercado, Angela Merritt, L. Michalowski, Päivi Miettunen, Marlene R. Miller, Diana Milojevic, Emily Mirizio, E. Misajon, M. Mitchell, Renee Modica, S. Mohan, Karen D. Moore, L. Nandini Moorthy, Sarah E. Morgan, Esi Morgan DeWitt, C. Moss, T. Moussa, V. Mruk, A. Murphy, Eyal Muscal, R. Nadler, B. Nahal, Kavita Nanda, N. Nasah, Lorien Nassi, Simona Nativ, Marc D. Natter, Jessica Neely, Becky Baltich Nelson, L. Newhall, Lawrence Ng, J. Nicholas, Rebecca Nicolai, Peter A. Nigrović, James J. Nocton, B. Nolan, Edward J. Oberle, B. Obispo, B. O’Brien, T. O’Brien, O. Okeke, Melissa Oliver, Judyann C. Olson, Kathleen M. O’Neil, Karen Onel, Amir B. Orandi, M. Orlando, Shirley‐Ann Osei‐Onomah, R. Oz, E. Pagano, Amy S. Paller, Nancy Pan, S. Panupattanapong, Manuela Pardeo, J. Paredes, Andrew S. Parsons, Jayesh Patel, K. Pentakota, Peri H. Pepmueller, T. Pfeiffer, K. Phillippi, Denise Pires Marafon, K. Phillippi, Lori Ponder, Rajdeep Pooni, Sampath Prahalad, S. Pratt, S. Protopapas, B. Puplava, J. Quach, M. Quinlan-Waters, candidate for director-at-large Daniel Rabinovich, Suhas M. Radhakrishna, J. Rafko, J. Raisian, Alexandria Rakestraw, Cristián Ramírez, E. Ramsay, Suzanne Ramsey, Rachel L. Randell, A. Reed, A. Reed, A. Reed, H. Reid, K. Remmel, A. Repp, A. Reyes, Al Richmond, Meredith Riebschleger, Sarah Ringold, M. Riordan, Mona Riskalla, M. Ritter, R. Rivas-Chacon, Angela Byun Robinson, E. Rodela, M. Rodriquez, K. Rojas, Tova Ronis, Margalit Rosenkranz, B. Rosolowski, H. Rothermel, Deborah Rothman, E. Roth-Wojcicki, Kelly Rouster‐Stevens, Tamar B. Rubinstein, Natasha M. Ruth, Nadine Saad, S. Sabbagh, E. Sacco, Rebecca E. Sadun, Christy Sandborg, A. Sanni, Leandro Rodrigues Santiago, Aliese Sarkissian, S. Savani, Lisabeth V. Scalzi, Laura E. Schanberg, S. Scharnhorst, Kenneth N. Schikler, Amanda R. Schlefman, Heinrike Schmeling, Kara Schmidt, E. Schmitt, Rayfel Schneider, K. Schollaert-Fitch, Grant S. Schulert, T. Seay, C. Seper, J. Shalen, R. Sheets, A. Shelly, Susan Shenoi, Kainaat Shergill, J. Shirley, Michael Shishov, C. Shivers, Earl D. Silverman, Nora G. Singer, Vidya Sivaraman, J. Sletten, Andrew Smith, Chelsey Smith, Jonathan P. Smith, J. Smith, Emily A. Smitherman, Jennifer B. Soep, Mary Beth F. Son, S. Spence, Lynn Spiegel, J. Spitznagle, R. Sran, Hemalatha Srinivasalu, H. Stapp, K. Steigerwald, Y. Sterba Rakovchik, Sara Stern, A. Stevens, B. Stevens, Robyn Stevenson, Katie Stewart, C. Stingl, J. Stokes, Matthew L. Stoll, Elizabeth Stringer, Sangeeta Sule, J. Sumner, Robert P. Sundel, M. Sutter, Saad Syed, Grant Syverson, Ann Marie Szymanski, Sarah F. Taber, Rotem Tal, Ajay Tambralli, A. Taneja, T. Tanner, S. Tapani, G. Tarshish, Stacey E. Tarvin, L. Tate, Alysha J. Taxter, Janalee Taylor, Michael A. Terry, Melissa Tesher, Akaluck Thatayatikom, B. Thomas, K. Tiffany, Tracy V. Ting, A. Tipp, D. Toib, Kathryn S. Torok, C. Toruner, Heather Tory, M. Toth, Shirley M. L. Tse, V. Tubwell, Marinka Twilt, S. Uriguen, T. Valcarcel, Heather Van Mater, L. Vannoy, Cherian Varghese, N. Vasquez, Kathleen M. Vazzana, Richard K. Vehe, Keila Veiga, J. Velez, James Verbsky, G. Vilar, N. Volpe, Emily von Scheven, Sheetal S. Vora, Joël Wagner, Linda Wagner‐Weiner, Dawn M. Wahezi, H. Waite, J. Walker, Heather Walters, Theresa Wampler Muskardin, L. Waqar, Michael Waterfield, M. Watson, A. Watts, Peter Weiser, Jennifer E. Weiss, Pamela F. Weiss, Elisa Wershba, Andrew J. White, Calvin B. Williams, A. Wise, Jennifer M. P. Woo, Leandra Woolnough, Tracey Wright, Eveline Y. Wu, Ali Yalçindağ, M. Yee, E. Yen, Rae S. M. Yeung, K. Yomogida, Qinze Yu, R. Zapata, A. Zartoshti, Andrew Zeft, R. Zeft, Y. Zhang, Yongdong Zhao, Austin Zhu, C. Zic · 发表于：Pediatric Rheumatology · 年份：2022 · DOI：10.1186/s12969-022-00770-y · 被引用次数：10 · 研究领域：Autoimmune and Inflammatory Disorders Research、Rheumatoid Arthritis Research and Therapies、Ocular Diseases and Behçet’s Syndrome

BACKGROUND: Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS: We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS: We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION: While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biolog...