PDF(Pubmed)
Abstract：
(1) Background: Achieving inactive disease decreases long-term joint damage in patients with polyarticular juvenile idiopathic arthritis (polyJIA). The aim of our study was to describe average time to treatment and medication changes over time. (2) Methods: Incident polyJIA patients were retrospectively identified in the InGef and WIG2 longitudinal health claims databases. Drug escalation level changes were evaluated longitudinally and cross-sectionally across three years, as follows: no treatment, glucocorticoids (GCs) and/or non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and biological disease-modifying antirheumatic drugs (bDMARDs). (3) Results: On average, newly diagnosed polyJIA patients received their first csDMARD prescription after 128 days and their first bDMARD prescription after 327 days. More patients were treated with csDMARDs than with bDMARDs at diagnosis; however, 24% and 12% (InGef and WIG2 databases, respectively) had no JIA treatment. After three years, 45% and 31% were not taking any treatments, while 18% and 36% were prescribed bDMARDs. Among patients initiating bDMARDs, most continued treatment for three years, with some switching to csDMARDs or discontinuing treatment. Patients treated only with csDMARDs took them longer, compared to those additionally taking other DMARDs. Patients treated with bDMARDs took them about twice as long as the csDMARDs they took prior. (4) Conclusion: A substantial number of patients with polyJIA are not treated as intensively as guidelines recommend.
摘要：
（1）背景：实现非活动性疾病可减少多关节型幼年特发性关节炎（polyJIA）患者的长期关节损伤。我们研究的目的是描述治疗的平均时间和药物随时间的变化。（2）方法：在InGef和WIG2纵向健康声明数据库中回顾性识别了多JIA患者。药物升级水平的变化在三年中进行了纵向和横截面评估，如下:不治疗，糖皮质激素（GC）和/或非甾体抗炎药（NSAIDs），常规合成抗风湿药（csDMARDs），和生物疾病缓解抗风湿药（bDMARDs）。（3）结果：平均而言，新诊断的polyJIA患者在128天后接受了他们的第一个csDMARD处方,在327天后接受了他们的第一个bDMARD处方.在诊断时，接受csDMARDs治疗的患者多于接受bDMARDs治疗的患者；然而，24%和12%(InGef和WIG2数据库，分别）没有JIA治疗。三年后,45%和31%没有接受任何治疗，而18%和36%的患者被处方为bDMARDs。在开始使用bDMARDs的患者中，最多持续治疗三年，有些人改用csDMARDs或停止治疗。仅使用csDMARDs治疗的患者需要更长的时间，与那些额外服用其他DMARD的人相比。用bDMARDs治疗的患者服用它们的时间大约是之前服用csDMARDs的两倍。（4）结论：大量的polyJIA患者没有像指南建议的那样得到严格的治疗。
