In Brief | Treatment-to-target strategies decreased pain for children with non-systemic JIA

Originally published in Pediatric Rheumatology

The BeSt for Kids study, a Dutch multicenter randomized trial, focused on non-systemic Juvenile Idiopathic Arthritis (JIA) patients aged 2 to 16 years with newly diagnosed JIA lasting less than 18 months. Involving 94 patients, the trial spanned two years, with three treatment arms: arm 1 with methotrexate (MTX) or sulfasalazine (SSZ) monotherapy, arm 2 with MTX and 6 weeks of prednisolone bridging, and arm 3 with initial treatment of etanercept (ETN) and MTX.

Patients were treated with th goal of achieving inactive disease, and the primary endpoint was pain intensity measured by a 100 mm visual analogue scale (VAS). Baseline characteristics indicated that higher VAS pain and an elevated active joint count correlated with increased pain levels over time. Conversely, low scores in VAS physician, CHQ Physical, and Psychosocial summary Score were associated with lower pain levels.

After two years, pain scores significantly decreased from a mean of 55.3 to 19.5, with an average monthly reduction of -1.37 mm. Over 70% of patients achieved inactive disease, with a significant impact on reducing VAS pain (β -16.87 mm) in inactive versus active disease. The study concludes that treatment-to-target effectively reduces pain in non-systemic JIA patients, regardless of the initial treatment strategy. However, some children still experience pain despite achieving clinically inactive disease, emphasizing the need to address patient-related outcomes alongside targeted treatment to minimize disease activity.

Dutch Trial Registry number 1574
 

Access the original article

Spekking, K., Anink, J., Bergstra, S. A., Schonenberg-Meinema, D., Koopman-Keemink, Y., Allaart, C. F., C. Brinkman, D. M., & E. Hissink Muller, P. C. (2023). Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: Results over 24 months of follow up. Pediatric Rheumatology Online Journal, 21. https://doi.org/10.1186/s12969-023-00874-z

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