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G383(P) Evaluation of an NHS Juvenile Idiopathic Arthritis (JIA) treatment pathway compared to published international recommendations
  1. KL Green,
  2. T Southwood,
  3. J McDonagh,
  4. M Twilt,
  5. P Davis,
  6. N Freeman
  1. Rheumatology Department, Birmingham Children’s Hospital, Birmingham, UK


Introduction The ACR recommendations for the treatment of Juvenile Idiopathic Arthritis (ACR-JIA) were published in 2011 with the aim of providing an evidence-based therapeutic pathway for safe and effective JIA treatment. Our aim was to determine the feasibility of applying ACR-JIA to a real-life paediatric JIA cohort and to evaluate the treatment pathway of those children.

Methods We conducted a retrospective analysis of a single-centre paediatric JIA cohort. This included a review of the patient case notes, radiology and drug monitoring data of all children with JIA diagnosed with multi-joint (5 or more joint) disease in the 2 years since ACR-JIA were published.

In total, 35 patients fulfilled ILAR criteria for diagnosis of JIA: systemic arthritis (n=5), polyarthritis (5) and extended Oligoarthritis (n = 5). Polyarthritis and extended oligoarthritis were analysed together and Systemics reviewed separately. To assess feasibility of the treatment pathways, duration to Methotrexate and Etanercept treatments was calculated, alongside frequency of drug monitoring.

Results 25 females and 10 males (median age at onset 13, range 1.5–15 years) were included in the evaluation. Median age at disease onset for poly/extended oligoarthritis was 10 years (1.5–16), with a median of 12 joints (12–38) active at presentation, and for the systemic group median age at onset was 6 years (2–7), with a median number of 6 active joints (2–10). 3 polyarthritis patients were rheumatoid factor positive (0 extended oligoarthritis and 0 systemics). The prognostic features and disease activity levels of the cohort are displayed in Table 1.

22/30 patients with polyarthritis/extended oligoarthritis followed the ACR recommendations for treatment according to their disease severity, commencing methotrexate therapy within a median of 6 weeks (3–37) of diagnosis and etanercept (where relevant) within a median of 7 months (3–24) of diagnosis. 7 patients did not follow ACR-JIA guidelines due to experiencing excessive durations (for disease severity) between diagnosis and commencing methotrexate or etanercept treatment. One patient did not have sufficiently regular drug monitoring.

Conclusions Overall, 27/35 patients followed the ACR-JIA recommendations. This evaluation highlights the difficulty of achieving rapid commencement of new JIA therapies and the challenging of ensuring regular drug monitoring in all patients.

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