{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T08:14:45Z","timestamp":1769847285817,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,6,5]],"date-time":"2020-06-05T00:00:00Z","timestamp":1591315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["QNT 69301"],"award-info":[{"award-number":["QNT 69301"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Undervaluing the effectiveness of conventional treatments may lead to overtreatment with biologic medications in children with juvenile idiopathic arthritis (<jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>). Using data from a nationwide inception cohort and strict methods to control bias, the aim of our study was to estimate the real\u2010world effectiveness of simple <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content> treatment strategies recommended in current guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children with <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content> who were recruited at 16 Canadian centers from 2005 to 2010 were followed for up to 5 years. For each child, all observed treatment changes over time were assessed by independent physicians using prospectively collected data and published response criteria. Success was defined as attainment of inactive disease or maintenance of this state when stepping down treatment; minimally active disease was deemed acceptable for children with polyarticular <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>. Success rates were calculated for treatments tried \u226525 times, and logistic regression analysis identified features associated with success.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 4,429 treatment episodes were observed in 1,352 children. Nonsteroidal antiinflammatory drug (<jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>) monotherapy was attempted 697 times, mostly as initial treatment when &lt;5 joints were involved, with a 54.4% success rate (95% confidence interval [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 50.3\u201358.6). <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s plus joint injections had a 64.7% success rate (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 59.8\u201369.7). Adding methotrexate to <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s and\/or joint injections (attempted 566 times) had a 60.5% success rate (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 55.7\u201365.3). In adjusted analyses, each additional active joint reduced chances of success for treatment with <jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 0.90 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.85\u20130.94]) and for methotrexate combinations (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.96 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.94\u20130.99]). Each additional year after disease onset reduced chances of success for treatment with methotrexate combinations (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.83 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.72\u20130.95]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These real\u2010world effectiveness estimates show that conventional nonbiologic treatment strategies that are recommended in current guidelines are effective in achieving treatment targets in many children with <jats:styled-content style=\"fixed-case\">JIA<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23922","type":"journal-article","created":{"date-parts":[[2019,5,10]],"date-time":"2019-05-10T07:38:47Z","timestamp":1557473927000},"page":"897-906","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Real\u2010World Effectiveness of Common Treatment Strategies for Juvenile Idiopathic Arthritis: Results From a Canadian Cohort"],"prefix":"10.1002","volume":"72","author":[{"given":"Amieleena","family":"Chhabra","sequence":"first","affiliation":[{"name":"British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiem","family":"Oen","sequence":"additional","affiliation":[{"name":"University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam M.","family":"Huber","sequence":"additional","affiliation":[{"name":"IWK Health Centre and Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie J.","family":"Shiff","sequence":"additional","affiliation":[{"name":"Shands Children's Hospital and University of Florida  Gainesville"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilles","family":"Boire","sequence":"additional","affiliation":[{"name":"Centre int\u00e9gr\u00e9 universitaire de sant\u00e9 et de services sociaux de l'Estrie Centre Hospitalier Universitaire de Sherbrooke and Universit\u00e9 de Sherbrooke  Sherbrooke Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne M.","family":"Benseler","sequence":"additional","affiliation":[{"name":"Alberta Children's Hospital and University of Calgary  Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2780-0617","authenticated-orcid":false,"given":"Roberta A.","family":"Berard","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre and Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosie","family":"Scuccimarri","sequence":"additional","affiliation":[{"name":"McGill University Health Centre and McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily Siok Hoon","family":"Lim","sequence":"additional","affiliation":[{"name":"University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Barsalou","sequence":"additional","affiliation":[{"name":"Centre hospitalier universitaire Sainte\u2010Justine and Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Bruns","sequence":"additional","affiliation":[{"name":"Centre int\u00e9gr\u00e9 universitaire de sant\u00e9 et de services sociaux de l'Estrie Centre Hospitalier Universitaire de Sherbrooke and Universit\u00e9 de Sherbrooke  Sherbrooke Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Cabral","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ga\u00eblle","family":"Ch\u00e9deville","sequence":"additional","affiliation":[{"name":"McGill University Health Centre and McGill University  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Ellsworth","sequence":"additional","affiliation":[{"name":"Stollery Children's Hospital and University of Alberta  Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Houghton","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Lang","sequence":"additional","affiliation":[{"name":"IWK Health Centre and Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Morishita","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dax G.","family":"Rumsey","sequence":"additional","affiliation":[{"name":"Stollery Children's Hospital and University of Alberta  Edmonton Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan M.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Royal University Hospital and University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirley M.","family":"Tse","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Watanabe Duffy","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario and University of Ottawa  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciaran M.","family":"Duffy","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario and University of Ottawa  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8977-2581","authenticated-orcid":false,"given":"Jaime","family":"Guzman","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"ReACCh\u2010Out Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213700"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30180-0"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2014.212"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213902"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34343"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38615"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20460"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003163421103"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22838"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706290"},{"key":"e_1_2_7_12_1","first-page":"355","article-title":"ROBINS\u2010I: a tool for assessing risk of bias in non\u2010randomised studies of interventions","volume":"12","author":"Sterne JA","year":"2016","journal-title":"BMJ"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12969-017-0161-5"},{"key":"e_1_2_7_14_1","volume-title":"Criteria for distinguishing effectiveness from efficacy trials in systematic reviews","author":"Gartlehner G","year":"2006"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24539"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205372"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400703"},{"key":"e_1_2_7_18_1","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty RE","year":"2004","journal-title":"J Rheumatol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.2217\/pme.11.7"},{"key":"e_1_2_7_20_1","first-page":"2290","article-title":"Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis","volume":"31","author":"Wallace CA","year":"2004","journal-title":"J Rheumatol"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.23916"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20860"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-207164"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131503"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.080560"},{"key":"e_1_2_7_26_1","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1136\/annrheumdis-2018-213030","article-title":"Treating juvenile idiopathic arthritis to target: recommendations of an international task force","volume":"77","author":"Ravelli A","year":"2018","journal-title":"Ann Rheum Dis"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.23922","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.23922","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.23922","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.23922","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T14:25:23Z","timestamp":1759415123000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.23922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,5]]},"references-count":25,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1002\/acr.23922"],"URL":"https:\/\/doi.org\/10.1002\/acr.23922","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,5]]},"assertion":[{"value":"2019-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}