DMARDs appear to be more effective for children with arthritis

Medications known as disease-modifying anti-rheumatic drugs, or DMARDs, appear to be more effective than other treatments for children with arthritis, but there is not enough evidence to support one kind of DMARD over another, according to a new report from HHS' Agency for Healthcare Research and Quality (AHRQ).

The report compared DMARDs with conventional treatments such as ibuprofen and steroids. It found that DMARDs are more effective than other treatments for improving symptoms of juvenile idiopathic arthritis, but the evidence was unclear about their long-term effectiveness and safety.

The new comparative effectiveness review was prepared for AHRQ's Effective Health Care Program by the Duke Evidence-based Practice Center. To accompany the new report, AHRQ also released today summary publications for consumers and clinicians explaining juvenile arthritis and options for treatment. The report and the companion guides are available at http://www.effectivehealthcare.ahrq.gov.

"The pain associated with juvenile arthritis can be debilitating and even excruciating for young patients and is a major concern for both patients and their families," said AHRQ Director Carolyn M. Clancy, M.D. "Until a cure for juvenile arthritis is found, patients want the best, safest treatment to relieve that pain. This report will help patients choose the right treatment together with their clinician."

Juvenile idiopathic arthritis, sometimes called juvenile rheumatoid arthritis, is a common childhood disease that affects up to 400 out of every 100,000 children in the United States. Juvenile idiopathic (meaning it has no known cause) arthritis is the most common form of persistent arthritis in children. It is marked by severe joint pain that is sometimes accompanied by a fever and rash and may cause long-term joint damage. There is no cure, but the development of DMARDs over the past 25 years has significantly advanced treatment and control of symptoms.

The AHRQ review compared traditional treatments—which include ibuprofen and other nonsteroidal anti-inflammatory drugs and corticosteroids—with DMARDs. The report also compared different types of DMARDs with each other. DMARDs work by interfering with immune cells that cause joint inflammation. They are typically classified as either biologic drugs, which target specific proteins in the immune system, or nonbiologic drugs, which act through a variety of different ways. In general, nonbiologic DMARDs are older. The nonbiologic DMARD methotrexate, which has been approved for treating arthritis since 1988, is often considered part of conventional treatment.

Researchers have hoped that the development of newer biologic DMARDs might put arthritis into long-term remission for more patients, but there are many unanswered questions about the safety of these drugs, especially for long-term use in children. The AHRQ report did not find evidence supporting the use of biologic DMARDs over nonbiologic DMARDs.