SAT0487\u2005THE OUTCOMES OF JUVENILE IDIOPATHIC ARTHRITIS (JIA) IN CHILDREN MANAGED WITH CURRENT TREATMENTS: THE SINGAPORE EXPERIENCE

Abstract

Background: JIA remains one of the most common rheumatic diseases afflicted children in SE Asia1. Despite the improvement in our treatment, outcomes of children treated with current therapy are unknown. Objectives: To describe the clinical outcomes of children with JIA in a large, single center cohort in Singapore Methods: Children diagnosed with JIA with a minimum follow-up of 6 month duration were recruited from our registry, from 1997 to 2015, at KK Women’s and Children’s Hospital, Singapore. Kaplan-Meier survival analyses were used to estimate the probability of ever attaining inactive disease (ID), remission with (CRM) or off (CR) medication according to modified Wallace criteria2. Revised Steinbroker functional classification was used to assess functional status of JIA patients at their last follow-up visit. Non-parametric descriptive statistics including median (IQR) were used to described data. Results: In a cohort of 251 children (62% male and 71% Chinese; 35% ERA, 34% oligoarthritis and 12% RF-negative polyarthritis were among the most common JIA subtypes encountered locally), 43% used biologics and 65% used methotrexate. Median follow-up was 35 months (IQR 13 – 70). Of all subtypes, 89%, 71% and 21% achieved ID, CRM and CR at least once during the course of follow-up, respectively. Over 85 – 100% of all JIA children could experience ID, including RF-positive polyarthritis (Fig. 1, 2). The probabilities of attaining ID within 1 and 5 years were 30 - 81% and 80 - 100%. The probabilities of attaining remission within 1 and 5 years were 10-59% and 67-100% across JIA subtypes. All of our psoriatic arthritis and systemic onset JIA reached remission on medication within 3 and 5 years, respectively. Only 33.6% of children could totally stop their medication at 1 year, but 19.3 – 87.0% could do so at 5 years. However, none of the RF-positive polyarthritis and undifferentiated JIA children had CR during the course of their diseases. Functional classes were achieved in 96%, 4%, 0.4% and 0% for class I – IV, respectively.Fig 1 Cumulative proportion of children attaining clinical inactive disease and clinical remission on medicationFig 2 Proportion of children achieving at least one time of clinical inactive disease and remission in each JIA category during the follow-up period. Conclusion: Majority of children with JIA managed by our current therapy attained inactive disease in 2 years. Despite significant improvement in JIA therapy, most of them remained on medications to maintain their inactive disease status. Only 20% were able to totally withdraw treatment. Almost all of our JIA children had no disability. References [1] Arkachaisri T, Tang SP, Daengsuwan T, Phongsamart G, Vilaiyuk S, Charuvanij S, et al. Paediatric rheumatology clinic population in Southeast Asia: are we different?Rheumatology. 2017Mar1;56(3):390-8. PubMed PMID: 27994096. [2] Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Annals of the rheumatic diseases. 2015Oct;74(10):1854-60. PubMed PMID: 24842571. Acknowledgement: National Arthritis Foundation of Singapore Disclosure of Interests: Thaschawee Arkachaisri Speakers bureau: Abbvie Pte, Ltd, Manasita Tanya: None declared, Yun Xin Book: None declared, Sook Fun Hoh: None declared, Xiaocong Gao: None declared, Lena Das: None declared