EULAR (European League Against Rheumatism): 2012 Congress

BERLIN – "Near remission," which is based on joint counts and acute phase reactants, predicts disease status at 3 years in patients with early inflammatory arthritis as well as the definition of remission that was proposed by the American College of Rheumatology/European League Against Rheumatism in 2011. The ACR/EULAR definition includes patient global assessment of status, according to Dr. Laure Gossec, who presented findings from the ESPOIR trial at the annual European Congress of Rheumatology.

"Near-remission is much more frequent than ACR/EULAR remission in early arthritis. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in early arthritis, as well as ACR/EULAR remission, or as the definition of remission that takes into account patient-reported fatigue. Near-remission may be a valid predictive outcome in early arthritis," said Dr. Gossec, associate professor of rheumatology at Descartes University, Paris, who currently is a visiting scholar at Manchester (England) University Arthritis Epidemiology Unit.

The 2011 ACR/EULAR proposed definition of Boolean remission of early rheumatoid arthritis comprises one or no tender joints; one or no swollen joints; C-reactive protein (CRP) level equal to or less than 1 mg/dL; and a patient global assessment score of no higher than 1 (Ann. Rheum. Dis. 2011;70:404-13). However, last year at the 2011 Annual European Congress of Rheumatology, some authors noted that patient global assessment was often a limiting factor to reach this remission, and proposed near-remission as an alternative outcome (Arthritis Rheum. 2011, ACR Congress, abstract 2459). "The question is would we lose predictive information, by not taking into account the patient’s point of view? And reversely, should we be assessing fatigue; would that add to predictive information?" Dr. Gossec noted in an interview.

Dr. Gossec and her associates undertook the ESPOIR observational study to assess if patient reported outcomes, particularly patient global and fatigue, predict radiologic joint destruction at 3 years, in patients already in near remission as judged by their joint counts and levels of acute phase reactants. Specifically, the investigators assessed the predictive value of both the ACR/EULAR proposed definition of remission at 6 and 12 months after diagnosis as well as the definition of "near remission," which included three of the four proposed ACR/EULAR end points but did not include patient global assessment of status, and "fatigue-remission" in which patient’s self-report of fatigue substitutes for the patient global.

Dr. Gossec and her associates followed 776 patients with early arthritis. The patients underwent swollen and tender joint counts and CRP measurements at 6 and 12 months after diagnosis. In addition, they completed a patient global assessment of their status at those times and a fatigue visual analog scale assessment. The outcome was change in the total Sharp-van der Heijde score between baseline and at 3 years.

Of the 776 patients, 57 patients (7.4%) met the proposed ACR/EULAR definition of remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission, and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% confidence interval, 0.43-0.60) and 0.39 (95% CI, 0.26-0.53), respectively. Prediction of radiographic progression was similar no matter which definition of remission was used.

However, the relation between radiographic progression and remission was strongest for the definition of near remission and the proposed ACR/EULAR remission. In stepwise selection only the variables in near-remission were predictive. Thus, it appears that the strongest drivers of radiographic progression are joint counts and acute phase reactants, and that for patients already in remission for those criteria, patient-reported outcomes add little to the prediction of radiographic progression. Dr. Gossec concluded that "assessing patient-reported outcomes is important to understand the patient’s perspective, but have only some added value to predict radiographic outcomes if objective criteria are already well controlled."

Dr. Gossec reported that she has no conflicts of interest that are relevant to this project.

BERLIN – "Near remission," which is based on joint counts and acute phase reactants, predicts disease status at 3 years in patients with early inflammatory arthritis as well as the definition of remission that was proposed by the American College of Rheumatology/European League Against Rheumatism in 2011. The ACR/EULAR definition includes patient global assessment of status, according to Dr. Laure Gossec, who presented findings from the ESPOIR trial at the annual European Congress of Rheumatology.

"Near-remission is much more frequent than ACR/EULAR remission in early arthritis. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in early arthritis, as well as ACR/EULAR remission, or as the definition of remission that takes into account patient-reported fatigue. Near-remission may be a valid predictive outcome in early arthritis," said Dr. Gossec, associate professor of rheumatology at Descartes University, Paris, who currently is a visiting scholar at Manchester (England) University Arthritis Epidemiology Unit.

The 2011 ACR/EULAR proposed definition of Boolean remission of early rheumatoid arthritis comprises one or no tender joints; one or no swollen joints; C-reactive protein (CRP) level equal to or less than 1 mg/dL; and a patient global assessment score of no higher than 1 (Ann. Rheum. Dis. 2011;70:404-13). However, last year at the 2011 Annual European Congress of Rheumatology, some authors noted that patient global assessment was often a limiting factor to reach this remission, and proposed near-remission as an alternative outcome (Arthritis Rheum. 2011, ACR Congress, abstract 2459). "The question is would we lose predictive information, by not taking into account the patient’s point of view? And reversely, should we be assessing fatigue; would that add to predictive information?" Dr. Gossec noted in an interview.

Dr. Gossec and her associates undertook the ESPOIR observational study to assess if patient reported outcomes, particularly patient global and fatigue, predict radiologic joint destruction at 3 years, in patients already in near remission as judged by their joint counts and levels of acute phase reactants. Specifically, the investigators assessed the predictive value of both the ACR/EULAR proposed definition of remission at 6 and 12 months after diagnosis as well as the definition of "near remission," which included three of the four proposed ACR/EULAR end points but did not include patient global assessment of status, and "fatigue-remission" in which patient’s self-report of fatigue substitutes for the patient global.

Dr. Gossec and her associates followed 776 patients with early arthritis. The patients underwent swollen and tender joint counts and CRP measurements at 6 and 12 months after diagnosis. In addition, they completed a patient global assessment of their status at those times and a fatigue visual analog scale assessment. The outcome was change in the total Sharp-van der Heijde score between baseline and at 3 years.

Of the 776 patients, 57 patients (7.4%) met the proposed ACR/EULAR definition of remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission, and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% confidence interval, 0.43-0.60) and 0.39 (95% CI, 0.26-0.53), respectively. Prediction of radiographic progression was similar no matter which definition of remission was used.

However, the relation between radiographic progression and remission was strongest for the definition of near remission and the proposed ACR/EULAR remission. In stepwise selection only the variables in near-remission were predictive. Thus, it appears that the strongest drivers of radiographic progression are joint counts and acute phase reactants, and that for patients already in remission for those criteria, patient-reported outcomes add little to the prediction of radiographic progression. Dr. Gossec concluded that "assessing patient-reported outcomes is important to understand the patient’s perspective, but have only some added value to predict radiographic outcomes if objective criteria are already well controlled."

Dr. Gossec reported that she has no conflicts of interest that are relevant to this project.

BERLIN – "Near remission," which is based on joint counts and acute phase reactants, predicts disease status at 3 years in patients with early inflammatory arthritis as well as the definition of remission that was proposed by the American College of Rheumatology/European League Against Rheumatism in 2011. The ACR/EULAR definition includes patient global assessment of status, according to Dr. Laure Gossec, who presented findings from the ESPOIR trial at the annual European Congress of Rheumatology.

"Near-remission is much more frequent than ACR/EULAR remission in early arthritis. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in early arthritis, as well as ACR/EULAR remission, or as the definition of remission that takes into account patient-reported fatigue. Near-remission may be a valid predictive outcome in early arthritis," said Dr. Gossec, associate professor of rheumatology at Descartes University, Paris, who currently is a visiting scholar at Manchester (England) University Arthritis Epidemiology Unit.

The 2011 ACR/EULAR proposed definition of Boolean remission of early rheumatoid arthritis comprises one or no tender joints; one or no swollen joints; C-reactive protein (CRP) level equal to or less than 1 mg/dL; and a patient global assessment score of no higher than 1 (Ann. Rheum. Dis. 2011;70:404-13). However, last year at the 2011 Annual European Congress of Rheumatology, some authors noted that patient global assessment was often a limiting factor to reach this remission, and proposed near-remission as an alternative outcome (Arthritis Rheum. 2011, ACR Congress, abstract 2459). "The question is would we lose predictive information, by not taking into account the patient’s point of view? And reversely, should we be assessing fatigue; would that add to predictive information?" Dr. Gossec noted in an interview.

Dr. Gossec and her associates undertook the ESPOIR observational study to assess if patient reported outcomes, particularly patient global and fatigue, predict radiologic joint destruction at 3 years, in patients already in near remission as judged by their joint counts and levels of acute phase reactants. Specifically, the investigators assessed the predictive value of both the ACR/EULAR proposed definition of remission at 6 and 12 months after diagnosis as well as the definition of "near remission," which included three of the four proposed ACR/EULAR end points but did not include patient global assessment of status, and "fatigue-remission" in which patient’s self-report of fatigue substitutes for the patient global.

Dr. Gossec and her associates followed 776 patients with early arthritis. The patients underwent swollen and tender joint counts and CRP measurements at 6 and 12 months after diagnosis. In addition, they completed a patient global assessment of their status at those times and a fatigue visual analog scale assessment. The outcome was change in the total Sharp-van der Heijde score between baseline and at 3 years.

Of the 776 patients, 57 patients (7.4%) met the proposed ACR/EULAR definition of remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission, and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% confidence interval, 0.43-0.60) and 0.39 (95% CI, 0.26-0.53), respectively. Prediction of radiographic progression was similar no matter which definition of remission was used.

However, the relation between radiographic progression and remission was strongest for the definition of near remission and the proposed ACR/EULAR remission. In stepwise selection only the variables in near-remission were predictive. Thus, it appears that the strongest drivers of radiographic progression are joint counts and acute phase reactants, and that for patients already in remission for those criteria, patient-reported outcomes add little to the prediction of radiographic progression. Dr. Gossec concluded that "assessing patient-reported outcomes is important to understand the patient’s perspective, but have only some added value to predict radiographic outcomes if objective criteria are already well controlled."

Dr. Gossec reported that she has no conflicts of interest that are relevant to this project.

BERLIN – Treatment with a drug that blocked the action of tumor necrosis factor led to a significant reduction of cardiovascular events in patients with rheumatoid arthritis, compared with treatment with methotrexate or other nonbiologic disease modifying antirheumatic drugs, in a review of more than 100,000 patients treated during routine practice, according to Dr. Michael T. Nurmohamed.

Although this finding adds to the accumulating circumstantial evidence that treating patients with rheumatoid arthritis (RA) with a drug that blocks tumor necrosis factor (TNF) reduces their cardiovascular disease risk better than does treatment with disease-modifying antirheumatic drugs (DMARDs), current evidence does not yet clearly support an early start to anti-TNF treatment to maximize cardiovascular risk reduction, Dr. Nurmohamed said in an interview at the annual European Congress of Rheumatology.

"However, the literature does indicate that effective inflammatory suppression is essential [for patients with RA], and that if this is not achieved within a reasonable time frame with high-dose methotrexate or another DMARD then treatment with a biological, anti-TNF drug should be considered," he noted.

"The rheumatologic aim of treatment should be minimal RA disease activity and preferably remission. An additional aim of treatment might be cardiovascular risk reduction. If anti-TNF treatment stops when an RA patient achieves disease remission, we need to know whether the arterial inflammatory process also stays in remission. Investigations of this are now underway, and these studies may reveal new biomarkers of cardiovascular risk in RA patients. Until these results are available, cardiovascular risk management in patients with RA should follow EULAR recommendations (Ann. Rheum. Dis. 2010;69:325-31)," said Dr. Nurmohamed, a rheumatologist at VU University Medical Centre in Amsterdam.

"It appears that in patients with RA, atherosclerotic plaques rupture earlier," he said in an interview. "We know that inflammation is very important in that process. It might be that when you treat patients with an anti-TNF drug or other anti-inflammatory, you reduce the inflammatory content of the plaque. Therefore the plaque ruptures later. That may be the way that anti-TNF drugs lower myocardial infarctions," according to Dr. Nurmohamed.

The new results he reported came from a review of 109,462 United States patients diagnosed with RA who had filled at least one prescription for an anti-TNF drug, methotrexate, or another DMARD, and were included in a database maintained by Thomson Reuters MarketScan The researchers reviewed the patient records following the date when they filled their index prescription until they developed a cardiovascular event, ended their enrollment in their health plan, or until 6 months after they stopped taking their index drug, whichever came first. The review included 48,210 patient-years of follow-up while on treatment with an anti-TNF drug, 13,540 patient-years of treatment with methotrexate, and 7,320 patient-years of treatment with another nonbiologic DMARD. The database included more than 75,000 patient-years of follow-up when patients received monotherapy with one of these three treatments, according to Dr. Nurmohamed.

During follow-up, 1,743 patients (1.6%) had a cardiovascular event, a myocardial infarction (MI), unstable angina, heart failure, or stroke. Events primarily occurred as MI, unstable angina, or heart failure. Dr. Nurmohamed said that he and his associates then ran a series of Cox proportional hazard models that assessed the outcomes from cumulative exposure to the various treatments and controlled for patient demographics, use of cardiovascular medications, smoking, comorbidities, hypertension, diabetes, history of cardiovascular events, and medical-resource use.

The analyses showed that for every 6 months of treatment with an anti-TNF drug, the rate of all cardiovascular events fell by 13%, compared with patients not treated with an anti-TNF drug. Six months of anti-TNF-drug treatment cut the rate of MIs specifically by 20%, compared with nonuse of an anti-TNF drug. Both effects were statistically significant.

The analyses also showed that the cardiovascular-event effect of anti-TNF drugs was cumulative. A year of use cut the cardiovascular event rate by 24%, 2 years cut the rate by 42%, and 3 years cut the rate by 56%, compared with patients who did not receive an anti-TNF drug, Dr. Nurmohamed reported. This cumulative effect was not surprising because "prolonged inflammatory suppression will lead to more pronounced risk reduction," he said.

The analyses also showed that the cardiovascular-risk reduction of treatment with an anti-TNF drug, compared with patients who did not get this drug class, was a statistically significant 14% in patients who were at least 50 years old, and a significant 15% in patients with no prior exposure to methotrexate. The analyses failed to find a significant impact on cardiovascular disease from treatment with methotrexate or other nonbiologic DMARDs.

Dr. Nurmohamed said that he had no relevant disclosures.

BERLIN – Treatment with a drug that blocked the action of tumor necrosis factor led to a significant reduction of cardiovascular events in patients with rheumatoid arthritis, compared with treatment with methotrexate or other nonbiologic disease modifying antirheumatic drugs, in a review of more than 100,000 patients treated during routine practice, according to Dr. Michael T. Nurmohamed.

Although this finding adds to the accumulating circumstantial evidence that treating patients with rheumatoid arthritis (RA) with a drug that blocks tumor necrosis factor (TNF) reduces their cardiovascular disease risk better than does treatment with disease-modifying antirheumatic drugs (DMARDs), current evidence does not yet clearly support an early start to anti-TNF treatment to maximize cardiovascular risk reduction, Dr. Nurmohamed said in an interview at the annual European Congress of Rheumatology.

"However, the literature does indicate that effective inflammatory suppression is essential [for patients with RA], and that if this is not achieved within a reasonable time frame with high-dose methotrexate or another DMARD then treatment with a biological, anti-TNF drug should be considered," he noted.

"The rheumatologic aim of treatment should be minimal RA disease activity and preferably remission. An additional aim of treatment might be cardiovascular risk reduction. If anti-TNF treatment stops when an RA patient achieves disease remission, we need to know whether the arterial inflammatory process also stays in remission. Investigations of this are now underway, and these studies may reveal new biomarkers of cardiovascular risk in RA patients. Until these results are available, cardiovascular risk management in patients with RA should follow EULAR recommendations (Ann. Rheum. Dis. 2010;69:325-31)," said Dr. Nurmohamed, a rheumatologist at VU University Medical Centre in Amsterdam.

"It appears that in patients with RA, atherosclerotic plaques rupture earlier," he said in an interview. "We know that inflammation is very important in that process. It might be that when you treat patients with an anti-TNF drug or other anti-inflammatory, you reduce the inflammatory content of the plaque. Therefore the plaque ruptures later. That may be the way that anti-TNF drugs lower myocardial infarctions," according to Dr. Nurmohamed.

The new results he reported came from a review of 109,462 United States patients diagnosed with RA who had filled at least one prescription for an anti-TNF drug, methotrexate, or another DMARD, and were included in a database maintained by Thomson Reuters MarketScan The researchers reviewed the patient records following the date when they filled their index prescription until they developed a cardiovascular event, ended their enrollment in their health plan, or until 6 months after they stopped taking their index drug, whichever came first. The review included 48,210 patient-years of follow-up while on treatment with an anti-TNF drug, 13,540 patient-years of treatment with methotrexate, and 7,320 patient-years of treatment with another nonbiologic DMARD. The database included more than 75,000 patient-years of follow-up when patients received monotherapy with one of these three treatments, according to Dr. Nurmohamed.

During follow-up, 1,743 patients (1.6%) had a cardiovascular event, a myocardial infarction (MI), unstable angina, heart failure, or stroke. Events primarily occurred as MI, unstable angina, or heart failure. Dr. Nurmohamed said that he and his associates then ran a series of Cox proportional hazard models that assessed the outcomes from cumulative exposure to the various treatments and controlled for patient demographics, use of cardiovascular medications, smoking, comorbidities, hypertension, diabetes, history of cardiovascular events, and medical-resource use.

The analyses showed that for every 6 months of treatment with an anti-TNF drug, the rate of all cardiovascular events fell by 13%, compared with patients not treated with an anti-TNF drug. Six months of anti-TNF-drug treatment cut the rate of MIs specifically by 20%, compared with nonuse of an anti-TNF drug. Both effects were statistically significant.

The analyses also showed that the cardiovascular-event effect of anti-TNF drugs was cumulative. A year of use cut the cardiovascular event rate by 24%, 2 years cut the rate by 42%, and 3 years cut the rate by 56%, compared with patients who did not receive an anti-TNF drug, Dr. Nurmohamed reported. This cumulative effect was not surprising because "prolonged inflammatory suppression will lead to more pronounced risk reduction," he said.

The analyses also showed that the cardiovascular-risk reduction of treatment with an anti-TNF drug, compared with patients who did not get this drug class, was a statistically significant 14% in patients who were at least 50 years old, and a significant 15% in patients with no prior exposure to methotrexate. The analyses failed to find a significant impact on cardiovascular disease from treatment with methotrexate or other nonbiologic DMARDs.

Dr. Nurmohamed said that he had no relevant disclosures.

BERLIN – Treatment with a drug that blocked the action of tumor necrosis factor led to a significant reduction of cardiovascular events in patients with rheumatoid arthritis, compared with treatment with methotrexate or other nonbiologic disease modifying antirheumatic drugs, in a review of more than 100,000 patients treated during routine practice, according to Dr. Michael T. Nurmohamed.

Although this finding adds to the accumulating circumstantial evidence that treating patients with rheumatoid arthritis (RA) with a drug that blocks tumor necrosis factor (TNF) reduces their cardiovascular disease risk better than does treatment with disease-modifying antirheumatic drugs (DMARDs), current evidence does not yet clearly support an early start to anti-TNF treatment to maximize cardiovascular risk reduction, Dr. Nurmohamed said in an interview at the annual European Congress of Rheumatology.

"However, the literature does indicate that effective inflammatory suppression is essential [for patients with RA], and that if this is not achieved within a reasonable time frame with high-dose methotrexate or another DMARD then treatment with a biological, anti-TNF drug should be considered," he noted.

"The rheumatologic aim of treatment should be minimal RA disease activity and preferably remission. An additional aim of treatment might be cardiovascular risk reduction. If anti-TNF treatment stops when an RA patient achieves disease remission, we need to know whether the arterial inflammatory process also stays in remission. Investigations of this are now underway, and these studies may reveal new biomarkers of cardiovascular risk in RA patients. Until these results are available, cardiovascular risk management in patients with RA should follow EULAR recommendations (Ann. Rheum. Dis. 2010;69:325-31)," said Dr. Nurmohamed, a rheumatologist at VU University Medical Centre in Amsterdam.

"It appears that in patients with RA, atherosclerotic plaques rupture earlier," he said in an interview. "We know that inflammation is very important in that process. It might be that when you treat patients with an anti-TNF drug or other anti-inflammatory, you reduce the inflammatory content of the plaque. Therefore the plaque ruptures later. That may be the way that anti-TNF drugs lower myocardial infarctions," according to Dr. Nurmohamed.

The new results he reported came from a review of 109,462 United States patients diagnosed with RA who had filled at least one prescription for an anti-TNF drug, methotrexate, or another DMARD, and were included in a database maintained by Thomson Reuters MarketScan The researchers reviewed the patient records following the date when they filled their index prescription until they developed a cardiovascular event, ended their enrollment in their health plan, or until 6 months after they stopped taking their index drug, whichever came first. The review included 48,210 patient-years of follow-up while on treatment with an anti-TNF drug, 13,540 patient-years of treatment with methotrexate, and 7,320 patient-years of treatment with another nonbiologic DMARD. The database included more than 75,000 patient-years of follow-up when patients received monotherapy with one of these three treatments, according to Dr. Nurmohamed.

During follow-up, 1,743 patients (1.6%) had a cardiovascular event, a myocardial infarction (MI), unstable angina, heart failure, or stroke. Events primarily occurred as MI, unstable angina, or heart failure. Dr. Nurmohamed said that he and his associates then ran a series of Cox proportional hazard models that assessed the outcomes from cumulative exposure to the various treatments and controlled for patient demographics, use of cardiovascular medications, smoking, comorbidities, hypertension, diabetes, history of cardiovascular events, and medical-resource use.

The analyses showed that for every 6 months of treatment with an anti-TNF drug, the rate of all cardiovascular events fell by 13%, compared with patients not treated with an anti-TNF drug. Six months of anti-TNF-drug treatment cut the rate of MIs specifically by 20%, compared with nonuse of an anti-TNF drug. Both effects were statistically significant.

The analyses also showed that the cardiovascular-event effect of anti-TNF drugs was cumulative. A year of use cut the cardiovascular event rate by 24%, 2 years cut the rate by 42%, and 3 years cut the rate by 56%, compared with patients who did not receive an anti-TNF drug, Dr. Nurmohamed reported. This cumulative effect was not surprising because "prolonged inflammatory suppression will lead to more pronounced risk reduction," he said.

The analyses also showed that the cardiovascular-risk reduction of treatment with an anti-TNF drug, compared with patients who did not get this drug class, was a statistically significant 14% in patients who were at least 50 years old, and a significant 15% in patients with no prior exposure to methotrexate. The analyses failed to find a significant impact on cardiovascular disease from treatment with methotrexate or other nonbiologic DMARDs.

Dr. Nurmohamed said that he had no relevant disclosures.

About half of the children with juvenile idiopathic arthritis who are treated with etanercept achieve inactive disease status, and those who experience early disease onset and lack of involvement of the wrist joint at baseline are more likely to do so, according to data presented by Dr. Nicoletta Solari during the pediatric rheumatology session of the annual European Congress of Rheumatology.

Dr. Solari presented findings from a chart review of 187 consecutive children with JIA who were treated with etanercept between 2002 and 2011 and then were followed for at least 6 months after treatment initiation.

Based on Wallace criteria for disease inactivity (J. Rheum. 2004;31:2290-4), 50.3% of patients had disease inactivity at their last follow-up, and the time to disease inactivity ranged from 2 months to 6.3 years, with a median of just 0.7 years, according to Dr. Solari of the University of Genoa, Italy.

The chart review showed that the strongest predictors of achieving inactive disease status at the last follow-up were age at onset of less than 3.6 years and lack of wrist joint involvement (adjusted odds ratio, 1.8 and 2.1, respectively).

"The patients included in the study had disease duration ranging from 3 months to 21 years, with a median duration of 5 years. Treatment duration from baseline to follow-up among the 173 patients who were treated for at least 6 months was up to 10.5 years, with a median of 2.4 years," Dr. Solari said in an interview.

All patients were treated with the standard 0.8 mg/kg per week dose of etanercept during the study period.

The increasing use of biologic agents, along with the results that have been seen with these agents, has raised the bar when it comes to expectations for remission in patients with juvenile idiopathic arthritis, but clinical studies of these agents typically fail to include assessment of remission, Dr. Solari said, noting that even less is known about the predictors of achieving remission.

"These findings indicate that about half of the children with JIA who are treated with etanercept in real-life clinical settings are able to attain a state of complete disease quiescence," according to Dr. Solari.

The findings are consistent with those reported from German and Dutch national registries, as well as from two previous studies that also aimed to evaluate the prevalence of inactive disease in patients whose JIA was treated with etanercept.

"Notably, these results refer to all JIA subtypes, including systemic patients," Dr. Solari said, explaining that several prior studies have shown that the systemic subtype of JIA responds less to etanercept than do the other disease categories.

The findings of the current study may have important implications for clinical practice.

"In our study, the lack of involvement of the wrist joint was the strongest predictor of both achievement of inactive disease at last follow-up visit and a shorter time to attainment of inactive disease after etanercept initiation," Dr. Solari said. This observation implies that wrist disease is a marker of poorer therapeutic outcome in children with JIA treated with etanercept, she noted.

"Thus, the presence of arthritis in the wrist joint might identify a subgroup of JIA patients with poorer outcome and who subsequently may have an indication for earlier introduction of etanercept during their disease course or the administration of etanercept in combination with methotrexate. This finding might help to improve the rate of remission," she said.

Session chair Dr. Nico Wulffraat of the University of Utrecht (the Netherlands) commented: "Many of us feel that involvement of the hips and neck are poor prognostic features."

Dr. Solari replied that she and her coinvestigators looked at that specifically, but they did not find a significant difference in response to etanercept with involvement of the joints.

About half of the children with juvenile idiopathic arthritis who are treated with etanercept achieve inactive disease status, and those who experience early disease onset and lack of involvement of the wrist joint at baseline are more likely to do so, according to data presented by Dr. Nicoletta Solari during the pediatric rheumatology session of the annual European Congress of Rheumatology.

Dr. Solari presented findings from a chart review of 187 consecutive children with JIA who were treated with etanercept between 2002 and 2011 and then were followed for at least 6 months after treatment initiation.

Based on Wallace criteria for disease inactivity (J. Rheum. 2004;31:2290-4), 50.3% of patients had disease inactivity at their last follow-up, and the time to disease inactivity ranged from 2 months to 6.3 years, with a median of just 0.7 years, according to Dr. Solari of the University of Genoa, Italy.

The chart review showed that the strongest predictors of achieving inactive disease status at the last follow-up were age at onset of less than 3.6 years and lack of wrist joint involvement (adjusted odds ratio, 1.8 and 2.1, respectively).

"The patients included in the study had disease duration ranging from 3 months to 21 years, with a median duration of 5 years. Treatment duration from baseline to follow-up among the 173 patients who were treated for at least 6 months was up to 10.5 years, with a median of 2.4 years," Dr. Solari said in an interview.

All patients were treated with the standard 0.8 mg/kg per week dose of etanercept during the study period.

The increasing use of biologic agents, along with the results that have been seen with these agents, has raised the bar when it comes to expectations for remission in patients with juvenile idiopathic arthritis, but clinical studies of these agents typically fail to include assessment of remission, Dr. Solari said, noting that even less is known about the predictors of achieving remission.

"These findings indicate that about half of the children with JIA who are treated with etanercept in real-life clinical settings are able to attain a state of complete disease quiescence," according to Dr. Solari.

The findings are consistent with those reported from German and Dutch national registries, as well as from two previous studies that also aimed to evaluate the prevalence of inactive disease in patients whose JIA was treated with etanercept.

"Notably, these results refer to all JIA subtypes, including systemic patients," Dr. Solari said, explaining that several prior studies have shown that the systemic subtype of JIA responds less to etanercept than do the other disease categories.

The findings of the current study may have important implications for clinical practice.

"In our study, the lack of involvement of the wrist joint was the strongest predictor of both achievement of inactive disease at last follow-up visit and a shorter time to attainment of inactive disease after etanercept initiation," Dr. Solari said. This observation implies that wrist disease is a marker of poorer therapeutic outcome in children with JIA treated with etanercept, she noted.

"Thus, the presence of arthritis in the wrist joint might identify a subgroup of JIA patients with poorer outcome and who subsequently may have an indication for earlier introduction of etanercept during their disease course or the administration of etanercept in combination with methotrexate. This finding might help to improve the rate of remission," she said.

Session chair Dr. Nico Wulffraat of the University of Utrecht (the Netherlands) commented: "Many of us feel that involvement of the hips and neck are poor prognostic features."

Dr. Solari replied that she and her coinvestigators looked at that specifically, but they did not find a significant difference in response to etanercept with involvement of the joints.

About half of the children with juvenile idiopathic arthritis who are treated with etanercept achieve inactive disease status, and those who experience early disease onset and lack of involvement of the wrist joint at baseline are more likely to do so, according to data presented by Dr. Nicoletta Solari during the pediatric rheumatology session of the annual European Congress of Rheumatology.

Dr. Solari presented findings from a chart review of 187 consecutive children with JIA who were treated with etanercept between 2002 and 2011 and then were followed for at least 6 months after treatment initiation.

Based on Wallace criteria for disease inactivity (J. Rheum. 2004;31:2290-4), 50.3% of patients had disease inactivity at their last follow-up, and the time to disease inactivity ranged from 2 months to 6.3 years, with a median of just 0.7 years, according to Dr. Solari of the University of Genoa, Italy.

The chart review showed that the strongest predictors of achieving inactive disease status at the last follow-up were age at onset of less than 3.6 years and lack of wrist joint involvement (adjusted odds ratio, 1.8 and 2.1, respectively).

"The patients included in the study had disease duration ranging from 3 months to 21 years, with a median duration of 5 years. Treatment duration from baseline to follow-up among the 173 patients who were treated for at least 6 months was up to 10.5 years, with a median of 2.4 years," Dr. Solari said in an interview.

All patients were treated with the standard 0.8 mg/kg per week dose of etanercept during the study period.

The increasing use of biologic agents, along with the results that have been seen with these agents, has raised the bar when it comes to expectations for remission in patients with juvenile idiopathic arthritis, but clinical studies of these agents typically fail to include assessment of remission, Dr. Solari said, noting that even less is known about the predictors of achieving remission.

"These findings indicate that about half of the children with JIA who are treated with etanercept in real-life clinical settings are able to attain a state of complete disease quiescence," according to Dr. Solari.

The findings are consistent with those reported from German and Dutch national registries, as well as from two previous studies that also aimed to evaluate the prevalence of inactive disease in patients whose JIA was treated with etanercept.

"Notably, these results refer to all JIA subtypes, including systemic patients," Dr. Solari said, explaining that several prior studies have shown that the systemic subtype of JIA responds less to etanercept than do the other disease categories.

The findings of the current study may have important implications for clinical practice.

"In our study, the lack of involvement of the wrist joint was the strongest predictor of both achievement of inactive disease at last follow-up visit and a shorter time to attainment of inactive disease after etanercept initiation," Dr. Solari said. This observation implies that wrist disease is a marker of poorer therapeutic outcome in children with JIA treated with etanercept, she noted.

"Thus, the presence of arthritis in the wrist joint might identify a subgroup of JIA patients with poorer outcome and who subsequently may have an indication for earlier introduction of etanercept during their disease course or the administration of etanercept in combination with methotrexate. This finding might help to improve the rate of remission," she said.

Session chair Dr. Nico Wulffraat of the University of Utrecht (the Netherlands) commented: "Many of us feel that involvement of the hips and neck are poor prognostic features."

Dr. Solari replied that she and her coinvestigators looked at that specifically, but they did not find a significant difference in response to etanercept with involvement of the joints.