THU0580 The acr recommendations for jia in daily clinical practice: are they followed or would treat-to-target therapy lead to better results?
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 AC...
Saved in:
Published in | Annals of the rheumatic diseases Vol. 77; no. Suppl 2; p. 491 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
London
BMJ Publishing Group LTD
01.06.2018
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | 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 |
---|---|
AbstractList | Background What 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. Objectives Are 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. Methods Monocentric retrospective cohort study analysing all OJIA and PJIA patients starting MTX for the first time between 2011 and 2016. Results The 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. Conclusions The 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 Interest None declared 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 |
Author | van Dijkhuizen, P. Swart, J.F. de Roock, S. Wulffraat, N. |
Author_xml | – sequence: 1 givenname: J.F. surname: Swart fullname: Swart, J.F. organization: Pediatric Rheumatology, UMC Utrecht, Utrecht, Netherlands – sequence: 2 givenname: S. surname: de Roock fullname: de Roock, S. organization: Pediatric Rheumatology, UMC Utrecht, Utrecht, Netherlands – sequence: 3 givenname: P. surname: van Dijkhuizen fullname: van Dijkhuizen, P. organization: Pediatric Rheumatology, UMC Utrecht, Utrecht, Netherlands – sequence: 4 givenname: N. surname: Wulffraat fullname: Wulffraat, N. organization: Pediatric Rheumatology, UMC Utrecht, Utrecht, Netherlands |
BookMark | eNpNkL1OwzAUhS0EEuXnHSx1DtiJ4xgWhBBQpEosZbZukhvqyrGL4wh1Y2HnGXkSHMrAdH_OufdI3wk5dN4hIXPOLjgv5CU4F9Y49q0ZspxxleFoIVyIsmQHZMaFVGkt2SGZMcaKTFzJ6picDMMmjUxxNSNfq8ULKxX7_vhcrZFCE2jAxvc9uhai8W6gnQ90Y4AaR1swdkcba5xpwNJtgCaaBq8pBKRxjbtktta_Y0vT0bsfbUtjQIhZ9FmE8IpxsgXY7qhFSKKnNcaIU-ow2jjcnJGjDuyA53_1lLw83K_uFtny-fHp7naZ1TxXLMvLtixVwRFlo6r0ineVEryWSuWd5LKVeXvVVVUtUHWizKFLTdJrFJDXpShOyXz_dxv824hD1Bs_Bpcidc4qzish2OSSe1fdb_Q2mB7CTnOmJ_r6H3090de_9PVEv_gB-TKCJg |
ContentType | Journal Article |
Copyright | 2018, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions Copyright: 2018 © 2018, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions |
Copyright_xml | – notice: 2018, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions – notice: Copyright: 2018 © 2018, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions |
DBID | 3V. 7X7 7XB 88E 88I 8AF 8FE 8FH 8FI 8FJ 8FK ABUWG AFKRA AZQEC BBNVY BENPR BHPHI BTHHO CCPQU DWQXO FYUFA GHDGH GNUQQ HCIFZ K9- K9. LK8 M0R M0S M1P M2P M7P PQEST PQQKQ PQUKI PRINS Q9U |
DOI | 10.1136/annrheumdis-2018-eular.4550 |
DatabaseName | ProQuest Central (Corporate) Health & Medical Collection ProQuest Central (purchase pre-March 2016) Medical Database (Alumni Edition) Science Database (Alumni Edition) STEM Database ProQuest SciTech Collection ProQuest Natural Science Collection Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central ProQuest Central Essentials Biological Science Collection ProQuest Central Natural Science Collection BMJ Journals ProQuest One Community College ProQuest Central Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Central Student SciTech Premium Collection Consumer Health Database (Alumni Edition) ProQuest Health & Medical Complete (Alumni) Biological Sciences Consumer Health Database Health & Medical Collection (Alumni Edition) PML(ProQuest Medical Library) Science Database Biological Science Database ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition ProQuest Central China ProQuest Central Basic |
DatabaseTitle | ProQuest Central Student ProQuest Central Essentials ProQuest Health & Medical Complete (Alumni) ProQuest AP Science ProQuest Central (Alumni Edition) SciTech Premium Collection ProQuest One Community College ProQuest Natural Science Collection ProQuest Family Health (Alumni Edition) ProQuest Central China ProQuest Central Health Research Premium Collection Health and Medicine Complete (Alumni Edition) Natural Science Collection ProQuest Central Korea Biological Science Collection ProQuest Medical Library (Alumni) ProQuest Science Journals (Alumni Edition) ProQuest Biological Science Collection ProQuest Central Basic ProQuest Science Journals ProQuest Family Health ProQuest One Academic Eastern Edition ProQuest Hospital Collection Health Research Premium Collection (Alumni) Biological Science Database ProQuest SciTech Collection ProQuest Hospital Collection (Alumni) ProQuest Health & Medical Complete ProQuest Medical Library ProQuest One Academic UKI Edition BMJ Journals ProQuest One Academic ProQuest Central (Alumni) |
DatabaseTitleList | ProQuest Central Student |
Database_xml | – sequence: 1 dbid: BENPR name: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1468-2060 |
GroupedDBID | --- .55 .GJ .VT 0R~ 23M 2WC 39C 3O- 3V. 4.4 40O 53G 5GY 5RE 5VS 6J9 7X7 7~S 88E 88I 8AF 8FE 8FH 8FI 8FJ 8R4 8R5 AAHLL AAKAS AAOJX AAWJN AAWTL ABAAH ABJNI ABKDF ABMQD ABOCM ABTFR ABUWG ABVAJ ACGFO ACGFS ACGOD ACGTL ACHTP ACMFJ ACOFX ACPRK ACTZY ADBBV ADCEG ADFRT ADUGQ ADZCM AEKJL AENEX AFKRA AFWFF AHMBA AHNKE AHQMW AJYBZ AKKEP ALIPV ALMA_UNASSIGNED_HOLDINGS ASPBG AVWKF AZFZN AZQEC BAWUL BBNVY BENPR BHPHI BKNYI BLJBA BOMFT BPHCQ BTFSW BTHHO BVXVI C1A C45 CAG CCPQU COF CS3 CXRWF DIK DWQXO E3Z EBS EJD F5P FRP FYUFA GNUQQ H13 HAJ HCIFZ HMCUK HYE HZ~ IAO IEA IGG IHR INH INR IOF J5H K9- KQ8 L7B LK8 M0R M1P M2P M7P N9A NTWIH NXWIF O9- OK1 OVD P2P PQQKQ PROAC PSQYO Q2X R53 RHF RHI RMJ RPM RV8 RWL RXW TAE TEORI TR2 UAW UKHRP UYXKK V24 VM9 VVN W2D W8F WH7 WOQ X6Y X7M YFH YOC YQY ZGI ZXP 7XB 8FK K9. PQEST PQUKI PRINS Q9U |
ID | FETCH-LOGICAL-b1280-25d55831ee6c87ead1f7841b6882f616d62d9f77b4e8f452af4e841bbe4a2b543 |
IEDL.DBID | BENPR |
ISSN | 0003-4967 |
IngestDate | Thu Oct 10 17:13:39 EDT 2024 Wed Aug 21 03:27:42 EDT 2024 |
IsDoiOpenAccess | false |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | Suppl 2 |
Language | English |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-b1280-25d55831ee6c87ead1f7841b6882f616d62d9f77b4e8f452af4e841bbe4a2b543 |
OpenAccessLink | https://ard.bmj.com/content/annrheumdis/77/Suppl_2/491.1.full.pdf |
PQID | 2071174404 |
PQPubID | 2041045 |
ParticipantIDs | proquest_journals_2071174404 bmj_primary_10_1136_annrheumdis_2018_eular_4550 |
PublicationCentury | 2000 |
PublicationDate | 20180600 20180601 |
PublicationDateYYYYMMDD | 2018-06-01 |
PublicationDate_xml | – month: 06 year: 2018 text: 20180600 |
PublicationDecade | 2010 |
PublicationPlace | London |
PublicationPlace_xml | – name: London |
PublicationTitle | Annals of the rheumatic diseases |
PublicationYear | 2018 |
Publisher | BMJ Publishing Group LTD |
Publisher_xml | – name: BMJ Publishing Group LTD |
SSID | ssj0000818 |
Score | 2.3053207 |
Snippet | BackgroundWhat factors drive the physician decision to escalate to anti-TNF therapy 3 and 6 months after start of methotrexate (MTX) in both persisting... Background What factors drive the physician decision to escalate to anti-TNF therapy 3 and 6 months after start of methotrexate (MTX) in both persisting... |
SourceID | proquest bmj |
SourceType | Aggregation Database Publisher |
StartPage | 491 |
SubjectTerms | Arthritis Clinical medicine Methotrexate Patients |
Title | THU0580 The acr recommendations for jia in daily clinical practice: are they followed or would treat-to-target therapy lead to better results? |
URI | http://dx.doi.org/10.1136/annrheumdis-2018-eular.4550 https://www.proquest.com/docview/2071174404 |
Volume | 77 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1LS8QwEA4-QLyIT1xfDOg1ummTNOtFVJRFUERc2FtpmhRXulvddpH9E_5mJ9kUD4KHQiEJhcx03jMfIWeoc61SQlE3i4ziw2imjaJKFrHJM5lr3_X--CT7A_4wFMMQcKtDWWUrE72gNlXuYuQuEsKYn2Z39fFJHWqUy64GCI1lshox7tK0qzd3T88vv7JYMdVi5vGeTNbIacAxcTAv0zc7G5tRjazCFLWu7vPcdfmintHj9z_S2auc-02yEWxFuF4Qd4ss2ck2WXsM2fAd8v3aH3SF6gLSGrJ8Cs67HY9twEmqAQ1SeB9lMJqAyUblHNo-SGiboy4hm1pAI3COm8uy-rIG8NCXA74GX4ROm4ouysVh0as1hxL5ApoKtG8Fwq_Ws7Kpr3bJ4P7u9bZPA74C1aiVujQSRggVM2tlrhI8ygqXhdQSre5CMmlkZHpFkmhuVcFFlBX4guva8izSgsd7ZGVSTew-AXSzcFuhYy0kqkWpuepxE2t0popcMdshF3ij6cdigkbqPY_Yd0O3NEgdDVJPg9TRoEOO2ttPw2_l9rRMcPD_8iFZ9zT14ZIjstJMZ_YYrYdGn5DlZJicBEb5ARADxic |
link.rule.ids | 315,786,790,12083,21416,27955,27956,31752,33777,43343,43838,74100,74657 |
linkProvider | ProQuest |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1Nj9MwELWgSIULgmVXFBYYabka6sZ2XC4VQlQB2p5aqbcojh1tq7QpTapV_8T-5h07jvaAxCFSJNuK5DeZL8_4EfIZba5VSijq7iKj-DCaaaOokkVk8kzm2ne9zxcyWfHfa7EOCbc6lFV2OtEralPlLkfuMiGM-dvsJoe_1LFGudPVQKHxlDzjUcSdnMfr-FETK6Y6xjw-lnGf3AQWE0fycry1p53Z1CgoTFHrqj6_uB5ftDJ6t_1HN3uDM31FXgZPEb630L4mT-z-gvTn4Sz8DblfJquhUENApCHLj-Bi293OBpakGtAdhe0mg80eTLYpz9B1QULXGvUNsqMFdAHPOLksqztrABfdOdpr8CXotKloWywObafWGUqUCmgq0L4RCL9an8qmnlyS1fTn8kdCA7sC1WiThnQkjBAqYtbKXMW4lBXuDFJL9LkLyaSRIzMu4lhzqwouRlmBLziuLc9GWvDoivT21d6-JYBBFk4rdKSFRKMoNVdjbiKNoVSRK2YH5CvuaHpo789IfdwR-V7oDoPUYZB6DFKHwYBcd7ufhp_KzelE4N3_hz-R58lyPktnvxZ_3pMXHl-fOLkmveZ4sh_Qj2j0Ry8sD3X6xsc |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1La-MwEBZ9QOil7PZBX7s70F7VRrElK72Upd2QPumhgdyMZUk0xYnT2CHkT_Q370iR6aHQg8EgCYNmPA_NfPoIOUOfa6Tkkrq7yCg-jGZKSyqFjXSeiVx51Pvjk-gP4rshH4b-pyq0VTY20RtqXebujNydhDDmb7O7sKEt4vmmdzV9p45BylVaA53GOtlEL9l2NA7JMPm0ypLJhj0v7oqkRU4Do4kjfJm9mvlYjypUGiapcR2g5w7vix5Hjd--2GnvfHo_yHaIGuHvSsw_yZqZ7JDWY6iL75KPl_6gzWUbUOqQ5TNwee54bAJjUgUYmsLbKIPRBHQ2KpbQICKhgUldQjYzgOHgEicXRbkwGnDRwlFgg29Hp3VJV43jsEJtLaFADYG6BOVBQfjVal7U1dUeGfT-vVz3aWBaoAr9U5t2uOZcRswYkcsElzLr6pFKYPxtBRNadHTXJomKjbQx72QWX3BcmTjrKB5H-2RjUk7MAQFMuHCaVZHiAh2kULHsxjpSmFbZXDJzSC5wR9Pp6i6N1OcgkcdFNzJInQxSL4PUyeCQnDS7n4YfzM1p1OHo--E_pIV6kj7cPt0fky0vXn-GckI26tnc_MKQola_va78B3xOyvM |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=THU0580+The+acr+recommendations+for+jia+in+daily+clinical+practice%3A+are+they+followed+or+would+treat-to-target+therapy+lead+to+better+results%3F&rft.jtitle=Annals+of+the+rheumatic+diseases&rft.au=Swart%2C+JF&rft.au=de+Roock%2C+S&rft.au=van+Dijkhuizen%2C+P&rft.au=Wulffraat%2C+N&rft.date=2018-06-01&rft.pub=BMJ+Publishing+Group+LTD&rft.issn=0003-4967&rft.eissn=1468-2060&rft.volume=77&rft.spage=491&rft_id=info:doi/10.1136%2Fannrheumdis-2018-eular.4550&rft.externalDBID=HAS_PDF_LINK |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0003-4967&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0003-4967&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0003-4967&client=summon |