Article Figures & Data
Figures
- Figure 1.
Importance and ratings of survey items for making decisions about withdrawing therapy for children with JIA and CID. Box plots show responses at the median (vertical black line), between the 25th and 75th percentiles (shaded rectangle), and outside the 25th and 75th percentiles (shaded lines), excluding outliers. ** Clusters of survey items (dark gray bars) were derived by principal components analysis; overall importance/rating of the cluster reflects the highest level among items within that cluster (light gray bars). JIA: juvenile idiopathic arthritis; CID: clinical inactive disease; SIJ: sacroiliac joint; TMJ: temporomandibular joint.
- Figure 2.
Influence of JIA category on likelihood of stopping medications for patients with CID. JIA: juvenile idiopathic arthritis; CID: clinical inactive disease; Oligo, Persist.: persistent oligoarticular JIA; Oligo, Extend.: extended oligoarticular JIA; RF: rheumatoid factor; Poly, RF neg.: RF-negative polyarticular JIA; Poly, RF pos.: RF-positive polyarticular JIA; Psor.: psoriatic JIA; ERA: enthesitis-related arthritis; Undiff.: undifferentiated JIA.
- Figure 3.
Minimum time that patients with JIA should have CID before withdrawing methotrexate or biologic monotherapy. JIA: juvenile idiopathic arthritis; CID: clinical inactive disease.
- Figure 4.
Strategies for withdrawing methotrexate or biologic monotherapy for patients with JIA and CID. Respondents could choose more than 1 strategy. JIA: juvenile idiopathic arthritis; CID: clinical inactive disease.
Tables
- Table 1.
Characteristics of survey respondents who reported taking care of children with JIA. Values are n (%).
Characteristics Total, n = 121 Clinical involvement Attending 105 (87) Fellow 13 (11) Nurse practitioner 3 (2) Yrs since training, excluding fellows < 5 26 (21) 5–9 23 (19) ≥ 10 59 (49) Clinical expertise Pediatric only 105 (87) Pediatric and adult 16 (13) Clinical time of total professional time, % ≥ 50% 88 (73) < 50% 33 (27) JIA Committee membership Yes 61 (50) No 60 (50) JIA: juvenile idiopathic arthritis.
- Table 2.
Considerations for withdrawing JIA medications and participants’ estimates of patient outcomes after treatment withdrawal. Values are n (%).
Survey Questions and Responses Values What factor(s), if present, would make you reluctant or hesitant to taper/stop MTX or a biologic drug for a patient who otherwise has had clinical inactive disease for a sufficient amount of time? (Assume the family is interested in stopping the medication.)* History of erosive joint disease 98 (81) Asymptomatic joint(s) with abnormalities on ultrasound (e.g., increased Doppler signal) or MRI (e.g., edema or enhancement) 87 (72) Failure of multiple prior DMARD/biologics 77 (64) Presence of brief morning stiffness (< 15 min) 23 (19) Intermittent joint pain with normal joint exam 13 (11) History of prior flares upon drug discontinuation** 5 (4) If a patient has inactive disease on combination MTX/biologic therapy, which do you prefer to taper/stop first? MTX 76 (63) Biologic 12 (10) Depends 33 (27) What specific factors are important in deciding which medicine to stop first?* History of toxicity or intolerance** 12 (10) Patient/family preference** 6 (5) Relative effect on disease control** 6 (5) Cost of or access to drug** 3 (2) Do you use imaging to determine whether to reduce/stop MTX/biologic therapy?† Often 11 (9) Sometimes 43 (36) Seldom 53 (44) Never 14 (12) Which imaging modalities do you use to guide your decision?*† MRI 87 (72) Ultrasound 38 (31) Radiograph 28 (23) Beyond discussing with the patient/family, do you use specific patient/parent-reported outcomes to decide whether to reduce/stop therapy?* 30 (25) Patient’s/parent’s global score 25 (21) Patient pain score 18 (15) Functional score (e.g., CHAQ) 15 (12) Quality of life score (e.g., PRQL) 3 (2) Among those who discontinued DMARD/biologic therapy, about what percentage flared within 1 yr? 0%–24% 19 (16) 25%–49% 47 (39) 50%–74% 31 (26) 75%–100% 1 (1) Not enough experience to give a number 23 (19) Among those who flared, about what percentage could you regain inactive disease within 3 mos by restarting their last medication regimen? (n = 97) 0%–24% 4 (4) 25%–49% 21 (22) 50%–74% 45 (46) 75%–100% 27 (28) ↵* Respondents could choose more than 1 answer.
↵** Factor listed by participants that was not a pre-existing survey choice.
↵† Not including arthritis of the temporomandibular joint. JIA: juvenile idiopathic arthritis; MTX: methotrexate; MRI: magnetic resonance imaging; DMARD: disease-modifying antirheumatic drug; CHAQ: Childhood Health Assessment Questionnaire; PRQL: Pediatric Rheumatology Quality of Life Scale.
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