TY - JOUR T1 - Trends in Medication Usage in Juvenile Idiopathic Arthritis: Prescribing Trends or Trends in Prescribers? JF - The Journal of Rheumatology JO - J Rheumatol SP - 1903 LP - 1905 DO - 10.3899/jrheum.140946 VL - 41 IS - 10 AU - DEBORAH LEVY Y1 - 2014/10/01 UR - http://www.jrheum.org/content/41/10/1903.abstract N2 - The International League of Associations for Rheumatology classification of juvenile idiopathic arthritis (JIA) defines 7 categories1 that represent diverse phenotypes, differing biology, and widely divergent disease courses. Treatment strategies differ between JIA categories; however, little is known about how recent treatment guidelines are interpreted and used by clinicians in routine patient care.In this issue of The Journal, Mannion, et al address an important gap in knowledge. These researchers obtained administrative data from a national US commercial insurer, representing about 8 million individuals across all 50 US states2. They examined diagnoses and prescriptions written over an 8-year period between 2005 and 2012, determining trends in medication usage for JIA. In particular, they focused on treatments prescribed following the introduction and increased uptake of the anti-tumor necrosis factor-α (anti-TNF-α) biologics.Healthcare researchers using administrative databases are able to examine large volumes of anonymized data, with the possibility of population-based research without individual recruitment and consent. In the current study, insurance diagnosis and prescription claims were used to identify patients with JIA. Their lenient diagnosis for JIA required only 1 JIA diagnostic code within 1 calendar year, with patients requalifying in the prevalence estimate each year. Although multiple validation studies of rheumatoid arthritis (RA) have demonstrated greater specificity when a greater number of encounters were required3,4, in this case the researchers increased the specificity of the claims diagnosis by studying patients who received prescriptions for disease-modifying antirheumatic drugs (DMARD) and biologics. In fact, the prevalence of JIA in the studied population was likely not greatly overestimated. If the covered individuals reflected the US population, then 24% (1.92 million) were < 18 years old, and the 500 to 1000 patients with JIA identified within each calendar year represent a yearly prevalence of less … Address correspondence to Dr. Levy. E-mail: deborah.levy{at}sickkids.ca ER -