A39: Efficacy and Safety of Methotrexate in Oligoarticular Persistent Juvenile Idiopathic Arthritis
Notice bibliographique
Résumé
Background/Purpose: Based on the ACR 2011 recommendations for the treatment of juvenile idiopathic arthritis (JIA) with persistent oligoarticular course methotrexate (MTX) is indicated for children with high disease activity and features of poor prognosis or if they failed intraarticular glucocorticoid steroid injections. However, no report has been published on MTX outcome in this category. Therefore our aim was to evaluate the efficacy and safety of MTX in children with oligoarticular persistent JIA. Methods: Baseline demographics, clinical characteristics and disease activity parameters have been prospectively documented in the German JIA Register. Efficacy was determined using the PedACR response criteria and the JADAS‐10. Safety assessments were based on adverse events reports from the responsible physician. Results: 343 patients with a total of 2039 visits were identified (894.7 total patient‐years). 67% (n = 231) were females. The median age at JIA onset was 4.7 years (quartile (Q) 25/75 2.5/9.2). At treatment initiation the median age was 8.0 years (Q25/75 4.3/12.0) and the disease duration 1.1 years (Q25/75 0.5/3.1). ANA positivity has been found in 63.0%, HLB27 positivity in 11.1%. Prior to MTX therapy 90.1% of children have been treated with nonsteroidal anti‐inflammatory drugs (NSAIDs), 46.1% have received intraarticular glucocorticoid steroid injections. 88.3 of children were treated concomitantly with NSAIDs, 11.5% with corticosteroids and 2.6% with other disease‐modifying antirheumatic drugs. A high proportion of patients showed a significant response to treatment. Compared to baseline disease activity parameters at MTX initiation, at month 6 70.5%/61.0%/41.5%, at month 12 73.9%/63.9%/43.5% and at month 24 83.6%/80.0%/69.7% of patients met the PedACR response criteria of 30%/50%/70%. The median JADAS‐10 at treatment start was 10.0 and decreased markedly to 2.1 at month 6, 1.4 at month 12 and 1.0 at month 24. At month 6 and month 12, 83 patients (33%) and 96 patients (42%) reached preliminary criteria for inactive disease. 113 children experienced 216 adverse events (AE) (24.7/100 patient–years). Four were reported as serious (0.4/100 patient–years (pj)). The most common reported AEs were nausea/vomiting (8.5/100 pj), abnormal liver enzymes (4.7/100 pj) and mild to moderate infections (3.6/100 pj). 48 children (14%) suffered from uveitis prior treatment. None of these patients flared with uveitis. Four new uveitis index cases (1.1%) were reported while on treatment. Treatment has been discontinued in 134 children for the following reasons: Inefficacy 3.2%, adverse events 9.8%, remission 24.3%, patients wish 16.5%, others 2.9%. 17 of 84 children (20.2%) who stopped MTX because of remission flared and re‐started MTX. Conclusion: MTX appears to be highly effective in oligoarticular persistent JIA. The treatment is safe and well‐tolerated. Few patients discontinued due to intolerance or inefficacy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».