Juvenile Psoriatic Arthritis Inception Cohort in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry: Characteristics and Early Disease Outcomes.

Abstract

OBJECTIVE To characterize the demographics, disease characteristics and treatment patterns of an inception cohort of children with psoriatic arthritis (jPsA) within the CARRA Registry. METHODS Patients diagnosed with jPsA within 6 months of CARRA Registry enrollment were included and observed for up to 24-months. Baseline disease characteristics, treatment history, disease activity measures, and patient reported outcomes were captured at 6-month intervals (+/- 3 months) at usual-care visits during the 24-month period. RESULTS 306 patients were included. Patients were predominantly female (62.4%) with a median (IQR) age of onset of 11.0 years (6.0-14.0). At Registry enrollment, 52.3% had polyarticular course, median active joint count was 3.0 (1.0-6.0), 20.1% had enthesitis, 34.3% had dactylitis, 9.5% had active sacroiliitis, and 58.8% had psoriasis. Tumor necrosis factor inhibitors (TNFi) were used in 61.1% and other biologic DMARDs in 13.4% of patients. 20.5% of patients received treatment with ≥2 biologic DMARDs or traditional synthetic DMARDs. cJADAS-10 improved from a median of 10.0 (5.5-15.0) at baseline to 1.0 (0.0-5.0) at 24 months. Improvements were also seen in active enthesitis and active sacroiliitis. CONCLUSION In this inception cohort of jPsA in the CARRA Registry, one-half of patients had polyarticular presentation, and the majority of patients required advanced therapy. Regardless of the treatment used, most patients had improvements in disease activity measures and patient reported outcomes, with most achieving clinically inactive disease. However, escalation of treatment was common, highlighting the unmet need for precision medicine in identifying the optimal initial drug for each individual patient.