To characterize disease modifying anti-rheumatic drug (DMARD) use for children with juvenile idiopathic arthritis (JIA) in the United States and determine patient factors associated with medication use.
We analyzed cross-sectional baseline enrollment data from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from May 2010 through May 2011 for children with JIA. Current and prior medication use was included. We used parsimonious backward stepwise logistic regression models to calculate odds ratios (OR) to estimate associations between clinical patient factors and medication use.
We identified 2,748 children with JIA with a median disease duration of 3.9 years from 51 U.S. clinical sites. Overall, 2,023 (74%) had ever received a non-biologic DMARD and 1,246 (45%) had ever received a biologic DMARD. Among children without systemic arthritis, methotrexate use was most strongly associated with uveitis (OR 5.2; 95% confidence interval [3.6–7.6]), cyclic citrullinated peptide antibodies (4.5 [1.7–12]), and extended oligoarthritis (4.1 [2.5–6.6]). Among children without systemic arthritis, biologic DMARD use was most strongly associated with rheumatoid factor positive (RF+) polyarthritis (4.3 [2.9–6.6]), psoriatic arthritis (3.0 [2.0–4.4]), and uveitis (2.8 [2.1–3.7]). Among children with systemic arthritis, 160 (65%) ever received a biologic DMARD; TNF inhibitor use was associated with polyarthritis (2.5 [3.8–16]) while IL-1 inhibitor use was not.
Approximately three-quarters of all children with JIA in the CARRA Registry received non-biologic DMARDs. Nearly one-half received biologic DMARDs, and their use was strongly associated with rheumatoid factor positive polyarthritis, psoriatic arthritis, uveitis, and systemic arthritis.