[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-227761-en":3,"doc-seo-227761-105":29,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":11,"language":21,"language_code":22,"site_id":23,"html_lang":22,"table_of_contents":24,"faqs":25,"seo_title":26,"seo_description":14,"update_tm":27,"read_time":28},227761,2336475104957,"นรินทร์","https://ap-avatar.wpscdn.com/avatar/22000c4c6bd8a5076e1?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787554080175789136",7,"Healthcare","Pediatric Rheumatology - 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 improve disease activity earlier in Disease Modifying Anti Rheumatic Drug (DMARD) naïve non-systemic Juvenile Idiopathic Arthritis (JIA). The BeSt for Kids study reports three-month clinical outcomes of initial treatment strategies. Methods: randomized arms compared initial DMARD monotherapy (sulfasalazine or methotrexate), MTX/prednisolone bridging, or MTX/etanercept combination; inactive disease and side effects were assessed using intention-to-treat analyses. Results: combination therapy achieved higher aACR Pedi70 responses at three months with toxicity comparable across arms. Conclusion: MTX/etanercept led to significantly more early clinical improvement than MTX or sulfasalazine monotherapy.","Hissink Muller et al. Pediatric Rheumatology (2017) 15:11 DOI 10.1186/s12969-017-0138-4  \nSHORT REPORT Open Access   \nA comparison of three treatment strategies  in recent onset non-systemic Juvenile Idiopathic Arthritis: initial 3-months  \nresults of the BeSt for Kids-study  \nP. C. E. Hissink Muller 1,6*, D. M. C. Brinkman 1,2, D. Schonenberg3, Y. Koopman-Keemink4, I. C. J. Brederije 1, W. P. Bekkering 1, T. W. Kuijpers3, M. A. J. van Rossum5, L. W. A. van Suijlekom-Smit6, J. M. van den Berg3, C. F. Allaart7 and R. ten Cate 1  \nAbstract  \nBackground: 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.  \nResults: 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.  \nAfter 3 months, aACR Pedi 50 was reached by 10/32 (31%), 12/32(38%) and 16/30 (53%) (p = 0.19) and aACRPedi 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.  \nConclusion: 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.  \nTrial registration: NTR1574 . Registered 3 December 2008 .  \nKeywords: Juvenile idiopathic arthritis, Treat to target, Window of opportunity, Treatment strategy study, Biologicals, Inactive disease  \n* Correspondence: [p.hissinkmuller@lumc.nl](p.hissinkmuller@lumc.nl)  \n1Department of Pediatrics/Pediatric Rheumatology, Leiden University Medical Center, Leiden, The Netherlands  \n6Department of Pediatrics/Pediatric Rheumatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands  \nFull list of author information is available at the end of the article  \n© The Author(s) . 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4 .0 International License ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ([http://creativecommons.org/publicdomain/zero/1.0/](http://creativecommons.org/publicdomain/zero/1.0/)) applies to the data made available in this article, unless otherwise stated.  \nIntroduction  \nJuvenile Idiopathic Arthritis (JIA) is the most common auto-immune disease in children [1] except for systemic JIA which is nowadays viewed as an autoinflammatory disease [2] . Many children suffer from chronic functional disability and damage due to prolonged inflammation [3] . The ILAR criteria divide the heterogeneous disease in 7 categories [4] . Prognosis is difficult to predict and even oligoarticular disease can ha","cbCaifBfYS2TzTQA","https://ap.wps.com/l/cbCaifBfYS2TzTQA","pdf",522934,1,"English","en",105,"# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n# Introduction\n# Methods\n## Patients","[{\"question\":\"What treatment strategies were compared in the BeSt for Kids study?\",\"answer\":\"Three arms compared initial DMARD monotherapy (sulfasalazine or methotrexate), initial MTX/prednisolone bridging, and initial combination MTX/etanercept.\"},{\"question\":\"How was clinical improvement evaluated after three months?\",\"answer\":\"Inactive disease outcomes were assessed using adjusted ACR Pedi30, 50, and 70 and JADAS at specified treatment weeks, using intention-to-treat analyses.\"},{\"question\":\"Which initial therapy produced the best three-month results?\",\"answer\":\"Initial MTX/etanercept combination therapy achieved significantly more early clinical improvement (aACR Pedi70) than initial MTX or sulfasalazine monotherapy.\"}]","Pediatric Rheumatology - 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