Use of biologic drugs in juvenile idiopathic arthritis patients followed in an adult rheumatology clinic: real-life data from the HUR-BIO biologic registry

Abstract

Objectives: This study aimed to determine whether there are differences in biologic treatment and complications according to subgroups of juvenile idiopathic arthritis (JIA) patients in adulthood.

Method: HUR-BIO (Hacettepe University Rheumatology Biologic Registry) has been a single-center biologic disease-modifying anti-rheumatic drug registry since 2005. Patients were selected from HUR-BIO who met the International League of Associations for Rheumatology classification criteria for juvenile idiopathic arthritis.

Results: Enthesitis-related arthritis (82, 49.1%), rheumatoid factor (-) polyarthritis (39, 23.4%), and rheumatoid factor ( +) polyarthritis (26, 15.6%) were the most prevalent subgroups in 167 JIA patients. Etanercept (105, 62.9%), adalimumab (28, 16.8%), and infliximab (21, 12.6%) were the most prescribed first-line biologic drugs. Secondary failure was the most common reason for the treatment changes among 42 (43.3%) patients, followed by non-life-threatening side effects in 12 (12.4%) and primary failure in 11 (11.3%). Polyarticular JIA showed higher HAQ (p = 0.020) and DAS28-ESR (p < 0.001) before biologics and had a longer disease duration to initiation of biologic treatment than enthesitis-related arthritis (p < 0.001). Only one patient (1.2%) in the enthesitis-related arthritis group needed the hip prosthesis, while 12 patients (18.5%) in the polyarticular JIA group required the same procedure (p < 0.001).

Conclusions: In adult rheumatology departments, the most common JIAs present with ongoing disease are enthesitis-related arthritis and polyarthritis. Secondary failure was the main reason nearly half of the patients needed biologic changes during follow-up. The polyarticular group appears to have a higher disease severity and level of disability. Key Points • The most of juvenile idiopathic arthritis patients in adult rheumatology clinics require biologics are enthesitis-related arthritis and polyarticular arthritis. • Approximately half of the patients require biologic changes during follow-up, most of these due to secondary failure. • Disease severity and disability appear to be higher in the polyarticular group, therefore treatment intensification may be considered.

Keywords: Biologic disease modifying anti-rheumatic drugs; Enthesitis related arthritis; Juvenile idiopathic arthritis.