No radiographic wrist damage after treatment to target in recent-onset juvenile idiopathic arthritis

Pediatr Rheumatol Online J. 2019 Sep 4;17(1):62. doi: 10.1186/s12969-019-0362-1.


Background: To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target.

Methods: Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration.

Results: In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from - 0,82; 0.68), nor for BA (varying from - 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (- 1.48; - 0.68) compared to arm 1 (- 0.84; - 0.04) and arm 2 (- 0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1).

Conclusions: Recent-onset JIA patients, treated-to-target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment.

Trial registration: NTR, NL1504 (NTR1574). Registered 01-06-2009.

Keywords: Conventional radiography; Juvenile idiopathic arthritis; Radiographic outcome; Treatment to target.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Antirheumatic Agents / therapeutic use
  • Arthritis, Juvenile / diagnostic imaging*
  • Arthritis, Juvenile / pathology
  • Bone Density
  • Child
  • Child, Preschool
  • Disease Progression
  • Etanercept / therapeutic use
  • Female
  • Humans
  • Male
  • Methotrexate / therapeutic use
  • Patient Care Planning
  • Radiography
  • Wrist / diagnostic imaging*
  • Wrist / pathology


  • Antirheumatic Agents
  • Etanercept
  • Methotrexate