University of Oulu

Tarkiainen, M., Tynjälä, P., Vähäsalo, P. et al. Health-related quality of life during early aggressive treatment in patients with polyarticular juvenile idiopathic arthritis: results from randomized controlled trial. Pediatr Rheumatol 17, 80 (2019) doi:10.1186/s12969-019-0370-1

Health-related quality of life during early aggressive treatment in patients with polyarticular juvenile idiopathic arthritis : results from randomized controlled trial

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Author: Tarkiainen, Maarit1,2; Tynjälä, Pirjo3; Vähäsalo, Paula4,5,6;
Organizations: 1Children’s Hospital, Helsinki University Central Hospital, Helsinki, Finland
2Pediatric Research Center, University of Helsinki, Helsinki, Finland HUS, P.O. Box 705, 00029, Helsinki, Finland
3Poison Information Centre, Helsinki University Central Hospital, Helsinki, Finland
4Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
5PEDEGO Research Unit, University of Oulu, Oulu, Finland
6Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
7Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2019
Publish Date: 2020-01-14


Background: Juvenile Idiopathic Arthritis (JIA) may cause significant impairment in health-related quality of life (HrQoL), despite effective therapies. The aim of this study was to assess HrQoL during first-year treatment in patients with new-onset polyarticular JIA, and to compare treatment strategies.

Methods: In ACUTE-JIA Study, 60 patients with new-onset JIA were randomized to receive either infliximab with methotrexate (IFX+MTX); a triple therapy of methotrexate, hydroxychloroquine, and sulfasalazine (Triple); or methotrexate monotherapy (MTX). Efficacy was measured with American College of Rheumatology pediatric (ACRp) score, and juvenile arthritis disease activity score (JADAS). HrQoL was evaluated with Child Health Questionnaire (CHQ), which includes physical and psychosocial summary scores (PhS and PsS). Linear mixed models were utilized to compare groups over time.

Results: In the whole group of 60 patients, mean physical summary score (PhS) improved from 26.2 (SD 8.7) at week 0 to 49.7 (SD 13.2) at week 54 (p=0.046). Mean improvement of PhS was 20.3 (95% CI -15.5 to 56.2); 22.6 (-19.5 to 64.7); and 26.6 (-12.1 to 65.3) in IFX+MTX, Triple, and MTX, respectively. Changes in psychosocial summary score (PsS) were smaller: from 51.0 (SD 8.5) to 54.7 (6.3) (p=0.019) in all patients. No differences between the three treatment groups were detected in either of the measures. In multivariate analyses, Child Health Assessment Questionnaire (CHAQ), pain VAS, and time spent in inactive disease contributed to improvement in PhS; gender and CHAQ to PsS.

Conclusions: HrQol improved during the first year on therapy for JIA irrespective of the treatment strategy. The timing of change in the different dimensions of HrQoL varied; improvement occurred earlier in physical than psychosocial domains of HrQol.

Trial registration: This study was registered within the Hospital District of Helsinki and Uusimaa ( clinical trials, number 211864 in October 2002, and later on with, number NCT01015547.

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Series: Pediatric rheumatology
ISSN: 1546-0096
ISSN-E: 1546-0096
ISSN-L: 1546-0096
Volume: 17
Article number: 80
DOI: 10.1186/s12969-019-0370-1
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: For this work, MT has received grants from The Finnish Cultural Foundation, The Finnish Medicine Foundation, and The Finnish Foundation for Research in Rheumatic Diseases.
Copyright information: © The Author(s) 2019. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, 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 ( applies to the data made available in this article, unless otherwise stated.