Table 2.

Considerations for withdrawing JIA medications and participants’ estimates of patient outcomes after treatment withdrawal. Values are n (%).

Survey Questions and ResponsesValues
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 disease98 (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/biologics77 (64)
  Presence of brief morning stiffness (< 15 min)23 (19)
  Intermittent joint pain with normal joint exam13 (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?
  MTX76 (63)
  Biologic12 (10)
  Depends33 (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?
  Often11 (9)
  Sometimes43 (36)
  Seldom53 (44)
  Never14 (12)
Which imaging modalities do you use to guide your decision?*
  MRI87 (72)
  Ultrasound38 (31)
  Radiograph28 (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 score25 (21)
  Patient pain score18 (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 number23 (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.