A comparison of three treatment strategies in recent onset non-systemic Juvenile Idiopathic Arthritis: Initial 3-months results of the BeSt for Kids-study

Background: combination therapy with prednisone or etanercept may induce earlier and/or more improvement in disease activity in disease modifying anti rheumatic drug (dmard) naïve non-systemic juvenile idiopathic arthritis (jia) patients. here we present three months clinical outcome of initial treatments of the best-for-kids study. methods: included patients were randomized to either: 1. initial dmard-monotherapy (sulfasalazine (ssz) or methotrexate (mtx)),2. initial mtx / prednisolone-bridging,3. initial combination mtx/etanercept. percentage inactive disease,adjusted (a) acr pedi30,50 and 70 and jadas after 6 and 12 weeks of treatment (intention to treat analysis) and side effects are reported. results: 94 patients (67% girls,32 (arm 1),32 (arm 2) and 30 (arm 3) with median (interquartilerange) age of 9.1 (4.7-12.9) years were included. 38% were ana positive,10 had oligo-articular disease,68 polyarticular jia and 16 psoriatic arthritis. baseline median (iqr) acrpedi-scores: vas physician 49 (40-58) mm,vas patient 54 (37-70) mm,esr 6.5 (2-14.8)mm/hr,active joint count 8 (5-12),limited joint count 3 (1-5),chaq score 0.88 (0.63-1.5). in arm 1,17 started with mtx,15 with ssz. after 3 months,aacr pedi 50 was reached by 10/32 (31%),12/32(38%) and 16/30 (53%) (p = 0.19) and aacr pedi 70 was reached by 8/32 (25%),6/32(19%) and 14/30(47%) in arms 1-3 (p = 0.04). toxicity was similar. few serious adverse events were reported. conclusion: after 3 months of treatment in a randomized trial,patients with recent-onset jia achieved significantly more clinical improvement (aacrpedi70) on initial combination therapy with mtx / etanercept than on initial mtx or ssz monotherapy. trial registration:ntr1574. registered 3 december 2008. © 2017 the author(s).