PMID- 37735435 OWN - NLM STAT- MEDLINE DCOM- 20230925 LR - 20231120 IS - 1478-6362 (Electronic) IS - 1478-6354 (Print) IS - 1478-6354 (Linking) VI - 25 IP - 1 DP - 2023 Sep 21 TI - Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes. PG - 177 LID - 10.1186/s13075-023-03166-9 [doi] LID - 177 AB - BACKGROUND: Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact of the time between JIA onset and the initiation of a bDMARD in achieving clinical remission, on physical disability and health-related quality of life (HRQoL). METHODS: Adult JIA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) and ever treated with bDMARD were included. Data regarding socio-demographic, JIA-related characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), and treatments were collected at the last visit. Patients were divided into 3 groups ( 5 years), according to the time from disease onset to bDMARD initiation. Regression models were obtained considering remission on/off medication, HAQ-DI, SF-36, and joint surgeries as outcomes and time from disease onset to bDMARD start as an independent variable. RESULTS: Three hundred sixty-one adult JIA patients were evaluated, with a median disease duration of 20.3 years (IQR 12.1; 30.2). 40.4% had active disease, 35.1% were in remission on medication, and 24.4% were in drug-free remission; 71% reported some degree of physical disability. Starting a bDMARD > 5 years after disease onset decreased the chance of achieving remission off medication (OR 0.24; 95% CI 0.06, 0.92; p = 0.038). Patients who started a bDMARD after 5 years of disease onset had a higher HAQ and worse scores in the physical component, vitality, and social function domains of SF-36, and more joint surgeries when compared to an earlier start. CONCLUSION: Later initiation of bDMARDs in JIA is associated with a greater physical disability, worse HRQoL, and lower chance of drug-free remission in adulthood. CI - (c) 2023. BioMed Central Ltd., part of Springer Nature. FAU - Oliveira Ramos, Filipa AU - Oliveira Ramos F AUID- ORCID: 0000-0001-7132-8909 AD - Pediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal. filipa.o.ramos@gmail.com. AD - Unidade de Investigacao Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal. filipa.o.ramos@gmail.com. AD - Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal. filipa.o.ramos@gmail.com. FAU - Rodrigues, Ana Maria AU - Rodrigues AM AD - Centre for Chronic Diseases (CEDOC), Nova Medical School, Lisbon, Portugal. AD - Comprehensive Health Research Centre, Nova Medical School, Lisbon, Portugal. FAU - Melo, Ana Teresa AU - Melo AT AD - Pediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal. AD - Unidade de Investigacao Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal. FAU - Aguiar, Francisca AU - Aguiar F AD - Young Adult and Pediatric Rheumatology Unit, Centro Hospitalar Universitario Sao Joao, University of Medicine of Porto University, Porto, Portugal. FAU - Brites, Luisa AU - Brites L AD - Rheumatology Department, Centro Hospitalar E Universitario de Coimbra, Coimbra, Portugal. FAU - Azevedo, Soraia AU - Azevedo S AD - Rheumatology Department, Unidade Local de Saude Do Alto Minho, Ponte de Lima, Portugal. FAU - Duarte, Ana Catarina AU - Duarte AC AD - Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal. FAU - Gomes, Jose Antonio Melo AU - Gomes JAM AD - Instituto Portugues de Reumatologia, Lisbon, Portugal. FAU - Furtado, Carolina AU - Furtado C AD - Rheumatology Department, Hospital Do Divino Espirito Santo, Ponta Delgada, Portugal. FAU - Mourao, Ana Filipa AU - Mourao AF AD - Centre for Chronic Diseases (CEDOC), Nova Medical School, Lisbon, Portugal. AD - Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. FAU - Sequeira, Graca AU - Sequeira G AD - Rheumatology Department, Centro Hospitalar Universitario Do Algarve, Faro Unit, Faro, Portugal. FAU - Cunha, Ines AU - Cunha I AD - Rheumatoloy Department, Centro Hospitalar Do Baixo Vouga, Aveiro, Portugal. FAU - Figueira, Ricardo AU - Figueira R AD - Rheumatoloy Department, Hospital Central Do Funchal, Funchal, Portugal. FAU - Santos, Maria Jose AU - Santos MJ AD - Unidade de Investigacao Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal. AD - Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal. AD - Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal. FAU - Fonseca, Joao Eurico AU - Fonseca JE AD - Pediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal. AD - Unidade de Investigacao Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal. AD - Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal. LA - eng PT - Journal Article DEP - 20230921 PL - England TA - Arthritis Res Ther JT - Arthritis research & therapy JID - 101154438 RN - 0 (Antirheumatic Agents) SB - IM MH - Adult MH - Humans MH - *Arthritis, Juvenile/drug therapy MH - Quality of Life MH - *Rheumatic Diseases MH - *Antirheumatic Agents/therapeutic use MH - Cognition PMC - PMC10512498 OTO - NOTNLM OT - Juvenile idiopathic arthritis OT - Long-term outcomes OT - Physical disability OT - Quality of life OT - bDMARDs COIS- The authors declare no competing interests. EDAT- 2023/09/22 06:42 MHDA- 2023/09/25 06:42 PMCR- 2023/09/21 CRDT- 2023/09/22 00:46 PHST- 2023/03/26 00:00 [received] PHST- 2023/09/11 00:00 [accepted] PHST- 2023/09/25 06:42 [medline] PHST- 2023/09/22 06:42 [pubmed] PHST- 2023/09/22 00:46 [entrez] PHST- 2023/09/21 00:00 [pmc-release] AID - 10.1186/s13075-023-03166-9 [pii] AID - 3166 [pii] AID - 10.1186/s13075-023-03166-9 [doi] PST - epublish SO - Arthritis Res Ther. 2023 Sep 21;25(1):177. doi: 10.1186/s13075-023-03166-9.