THU0580 The acr recommendations for jia in daily clinical practice: are they followed or would treat-to-target therapy lead to better results?

• Published in: Annals of the rheumatic diseases Vol. 77; no. Suppl 2; p. 491
• Main Authors: Swart, J.F., de Roock, S., van Dijkhuizen, P., Wulffraat, N.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2018
• Subjects: Arthritis; Clinical medicine; Methotrexate; Patients
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2018-eular.4550

BackgroundWhat factors drive the physician decision to escalate to anti-TNF therapy 3 and 6 months after start of methotrexate (MTX) in both persisting oligoarthritis (OJIA) and polyarticular course (PJIA) juvenile idiopathic arthritis.ObjectivesAre the escalation-decisions in accordance with the ACR JIA treatment recommendations (ACR-CPG)1 and if not, what factors drive these decisions. How does it perform as a “prognostic” test to predict failure when not escalated. Could the clinical Juvenile Arthritis Disease Activity Score (cJADAS) be used instead. What is the value of the patient-VAS in the ACR-CPG, the physician decision and in the cJADAS.MethodsMonocentric retrospective cohort study analysing all OJIA and PJIA patients starting MTX for the first time between 2011 and 2016.ResultsThe ACR-CPG is mostly not followed and implementation would increase the anti-TNF-use from 12.0% to 65.1%. However, the physician decision not to escalate was now correct in 70%–75%, therefor implementation results in an overuse of anti-TNF. Some items of the ACR-CPG were non-discriminatory. The use of cJADAS in predicting failure if not escalated outperformed the ACR-CPG with a much higher sensitivity and specificity for the OJIA and PJIA group respectively. The omission of the patient-VAS-scores resulted in a substantial decrease of the identification of patients failing to respond without escalation.ConclusionsThe ACR-CPG not only is too complicated to be applicable in clinical practice, it also fails to identify those patients really in need of escalation to anti-TNF. The cJADAS can be used instead since this is user-friendly, does not require waiting for ESR results and performs better than the ACR-CPG. The patient-VAS is a critical item for the decision to escalate.Reference[1] Beukelman T, et al. 2011American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken)2011;63:465–82.Disclosure of InterestNone declared