Editorial board comment
In this ground-breaking article by Simonini et al, investigators found that children with oligoarticular and polyarticular types of juvenile idiopathic arthritis (JIA) who discontinued treatment prior to 2 years after remission were more likely to experience flares of disease. This study is important because it is one of the first to focus on length of treatment in pediatric JIA.
One of the most common questions I am asked by parents is how long their child will need to take medications. This is something all pediatric rheumatologists struggle with– the balance of keeping the arthritis under control vs. long-term risk of immunosuppressive medications. In the above study, after 6 months in remission and off therapy, most of the participants (75%) experienced a flare. These data are important and point out the slow process involved in “re-setting” the body’s immune response to stop autoimmune disease.
Another important lesson for me after reading this study is how difficult it can be to predict who will flare. The current study was not designed to assess potential biomarkers for disease flares, but previous studies have found increased inflammatory proteins in children who subsequently had a flare of JIA. If we had a biomarker, or panel of biomarkers, that could accurately predict disease course, we could customize therapies for children with JIA. This is the dream for all clinicians, and the hope is that with studies such as this we can one day reach this goal.