Children with juvenile idiopathic arthritis (JIA) treated with multiple medications soon after the disease appears spend more time without symptoms than those treated with a single drug or those who start aggressive treatment later, according to research presented at the American College of Rheumatology 2013 Annual Meeting in San Diego. This builds on an earlier study showing that treating JIA early and aggressively is more effective than starting slowly and stepping up to stronger therapies over time.

JIA, which affects about 300,000 children in the United States, is an umbrella term for several types of childhood arthritis that cause chronic joint inflammation and in some cases symptoms such as fever, rash and eye problems. Like other autoimmune conditions, the immune system – which is designed to protect our health by attacking foreign cells such as viruses and bacteria – becomes overactive and attacks the body’s own tissues.

The current study is the first to use the complete absence of arthritis symptoms (called “clinical inactive disease”) and remission (no symptoms for six continuous months) as study outcomes, says lead investigator Carol A. Wallace, MD, professor of pediatrics at the University of Washington Medical Center and Seattle Children’s Hospital.

“The study shows that the longer you wait to start aggressive treatment, the less chance children have of achieving [a complete absence of symptoms] and that a [strong] early response is important,” Dr. Wallace notes. “There definitely is a window of opportunity.”

To learn which of two treatment strategies would help children with JIA become symptom-free within six months of starting therapy – and stay symptom-free – Dr. Wallace and colleagues analyzed data from a 2011 clinical trial known as TREAT. The trial compared methotrexate (a disease-modifying antirheumatic drug or DMARD) to an aggressive combination therapy of methotrexate plus the biologic entanercept (Enbrel) plus the corticosteroid prednisolone (which was tapered after 17 weeks).

Eighty-five children ages 2 to 17 participated in the trial. Most had been recently diagnosed (within six months) with polyarticular JIA, a form of arthritis affecting five or more joints, and all were quite sick.

“These patients had a very high burden of disease,” Dr. Wallace explains.

At the start of the study, 42 children received the combination therapy and 43 were treated with methotrexate only. They were followed for a year and tested regularly to see how well they were doing.

“[We found] that patients on the more-aggressive treatment spent more time in inactive disease than patients on methotrexate alone – 139 days compared with 79 days. More important, those who had a robust, early response had many more periods of inactive disease over the entire 12 months,” Dr. Wallace says.