RT Journal Article
SR Electronic
T1 Predictors of Flare Following Etanercept Withdrawal in Patients with Rheumatoid Factor–negative Juvenile Idiopathic Arthritis Who Reached Remission while Taking Medication
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 956
OP 961
DO 10.3899/jrheum.170794
VO 45
IS 7
A1 Angela Aquilani
A1 Denise Pires Marafon
A1 Emiliano Marasco
A1 Rebecca Nicolai
A1 Virginia Messia
A1 Francesca Perfetti
A1 Silvia Magni-Manzoni
A1 Fabrizio De Benedetti
YR 2018
UL http://www.jrheum.org/content/45/7/956.abstract
AB Objective. To evaluate the rate of flare after etanercept (ETN) withdrawal in patients with juvenile idiopathic arthritis (JIA) who attained clinical remission while taking medication, and to identify predictors of flare.Methods. Patients were included with oligo- (oJIA) and rheumatoid factor–negative polyarticular JIA (pJIA) who received a first course of ETN for at least 18 months, maintained clinically inactive disease (CID) for at least 6 months during treatment, and were followed for 12 months after ETN withdrawal. Demographic and clinical features were collected at onset, at baseline (initiation of ETN), and at time of disease flare.Results. After ETN withdrawal, 66 of the 110 patients enrolled (60%) flared with arthritis (of whom 7 flared with concurrent anterior uveitis; none with uveitis alone). The median time to flare was 4.3 months (interquartile range 2.5–6.4) with no evident differences between oJIA and pJIA. The number and type of joints involved at baseline and characteristics of ETN treatment/discontinuation were not associated with flare. Patients who flared were more frequently males (p = 0.034), positive for antinuclear antibody (ANA; p = 0.047), and had higher values of C-reactive protein (CRP; p = 0.012) at baseline. These variables remained significantly associated with flare in a multivariate logistic analysis, a model accounting for only 14% of the variability of the occurrence of the flare.Conclusion. Our results show that a significant proportion of patients with JIA who maintain CID for at least 6 months experience a relapse after ETN withdrawal. Male sex, presence of ANA, and elevated CRP at baseline were associated with higher risk of flare.