TY - JOUR T1 - Early Aggressive Therapy for Patients with Juvenile Idiopathic Arthritis: Are We There Yet? JF - The Journal of Rheumatology JO - J Rheumatol SP - 2343 LP - 2346 DO - 10.3899/jrheum.141051 VL - 41 IS - 12 AU - ROBERTA A. BERARD AU - RONALD M. LAXER Y1 - 2014/12/01 UR - http://www.jrheum.org/content/41/12/2343.abstract N2 - This is an extremely exciting time in the field of pediatric rheumatology. Advances in understanding the pathogenesis of juvenile idiopathic arthritis (JIA) have led to novel treatments with resultant marked improvements in patient outcomes, as is eloquently summarized in a review by Lovell and colleagues1.Critical to the study of these new therapies has been the development of standardized outcome measures. These are not only relevant to research studies but also assist in making treatment decisions in clinical practice. The definition of improvement by the American College of Rheumatology (ACR) core set response criteria2 and more recently, criteria of inactive disease and remission, both on and off medication, have been developed and adopted by the ACR3 (Table 1). Application of these standardized outcome measures has greatly facilitated the reporting and generalizing of study results, as well as allowed comparison of results between trials.View this table:In this windowIn a new windowTable 1. ACR definitions of clinical inactive disease and clinical remission for JIA. From: Wallace, et al. Arthritis Care Res 2011;63:929–363; with permission.Earlier studies, in the “prebiologics era,” used differing measures for reporting remission and classifying patients; and the length of followup varied. As a result, it was extremely difficult to compare results between studies. A Canadian multicenter retrospective cohort study reported that 10 years following diagnosis of juvenile rheumatoid arthritis4, the probability of remission (defined as 2 years without taking medication) was 37% in patients with systemic disease, 47% in oligoarthritis, 23% in rheumatoid factor (RF)-negative polyarthritis, and 6% in RF-positive polyarthritis5. This is in contrast to a multicenter retrospective cohort study (Italy and the United States) in which, after a median of 7.7 years post-JIA diagnosis (similar categories considered as above), 40% of patients were in remission (defined as 6 months without taking medication). However, … Address reprint requests to Dr. Laxer; E-mail: ronald.laxer{at}sickkids.ca ER -