Treatment of systemic juvenile idiopathic arthritis: conventional treatment versus biologics

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OBJECTIVE: We aimed to identify and compare systemic juvenile idiopathic arthritis (sJIA) patients receiving treatment with either glucocorticoids and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or biologic drugs. METHODS: This was a retrospective cross-sectional study. sJIA patients (n=138) were categorized into two groups: Group A (n=51) consisted of individuals who received only glucocorticoids and/or csDMARDs, while Group B (n=87) included those who received at least one biologic drug. RESULTS: Group B patients exhibited a higher prevalence of macrophage activation syndrome (MAS) (p=0.001) at presentation. C-reactive protein (CRP) levels and systemic Juvenile Arthritis Disease Activity Scores (sJADAS) at diagnosis were significantly higher in Group B (p<0.001). A higher proportion of Group B were able to discontinue glucocorticoid treatment in a shorter timeframe (p<0.001), and a higher number of patients in this group successfully discontinued glucocorticoids within the first year (p<0.001). Presentation with MAS (odds ratio [OR] 3.419, 95% confidence interval [CI] 1.194-9.792; p=0.022), polycyclic disease course (OR 4.351, 95% CI 1.329-14.240; p=0.015), CRP levels >13.6 mg/dL (OR 2.838, 95% CI 1.182-6.815; p=0.020) and sJADAS >24.1 (OR 4.490, 95% CI 1.725-11.684; p=0.002) at diagnosis were independent predictors of biologic requirement in treatment. CONCLUSIONS: Patients with a history of MAS, polycyclic disease course, elevated CRP, and high sJADAS at diagnosis may require biologic drugs in the treatment. This observation could help clinicians tailor treatment according to the individual needs of sJIA patients.