Disease Recapture Rates After Medication Discontinuation and Flare in JIA: An Observational Study within the Childhood Arthritis and Rheumatology Research Alliance Registry

OBJECTIVE: Children with well-controlled juvenile idiopathic arthritis (JIA) frequently flare after medication discontinuation, but the outcomes of these flares have not been well described. The objective of this study was to characterize the rates and predictors of disease recapture among children with JIA who restarted medication to treat disease flare.

METHODS: Children with JIA who discontinued conventional synthetic or biologic disease-modifying antirheumatic drugs for well-controlled disease but subsequently flared and restarted medication(s) were identified from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. The primary outcome was inactive disease (ID; physician global < 1 and active joint count = 0) 6 months after flare.

RESULTS: 333 patients had complete data for ID at 6 months after flare. The recapture rate for the cohort was 55%, ranging from 47% (persistent oligoarthritis) to 69% (systemic arthritis) (p=0.4). Approximately 67% of children achieved ID by 12 months. In the multivariable model, history and re-initiation of biologic drugs were associated with were associated with increased odds of successful recapture (OR 4.79 (95%CI: 1.22-18.78) and 2.74 (95%CI: 1.62-4.63), respectively. Number of joints with limited range of motion was associated with decreased odds (OR 0.83 per 1 joint increase; 95% CI: 0.72-0.95).

CONCLUSION: Approximately half of JIA flares post-discontinuation were recaptured within 6 months, but rates of recapture varied across JIA categories. These findings inform shared decision-making for patients, families, and clinicians regarding the risks and benefits of medication discontinuation. Better understanding of biologic predictors of successful recapture in JIA are needed. This article is protected by copyright. All rights reserved.