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01.12.2019 | Research article | Ausgabe 1/2019 Open Access

Pediatric Rheumatology 1/2019

No radiographic wrist damage after treatment to target in recent-onset juvenile idiopathic arthritis

Pediatric Rheumatology > Ausgabe 1/2019
P. C. E. Hissink Muller, W. G. van Braak, D. Schreurs, C. M. Nusman, S. A. Bergstra, R. Hemke, D. Schonenberg-Meinema, J. M. van den Berg, T. W. Kuijpers, Y. Koopman-Keemink, M. A. J. van Rossum, L. W. A. van Suijlekom-Smit, D. M. C. Brinkman, C. F. Allaart, R. ten Cate, M. Maas
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12969-019-0362-1) contains supplementary material, which is available to authorized users.
PCE Hissink Muller, WG van Braak and D Schreurs shared first author.
R ten Cate and M Maas shared last author.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



To evaluate radiographic progression of patients with new-onset juvenile idiopathic arthritis (JIA) in response to an early, tightly-controlled, treatment-to-target.


Patients with JIA participating in the BeSt-for-Kids-study, randomized to 3 treatment strategy arms, were eligible if at least 1 conventional wrist-radiograph was available. Bone damage as reflected by carpal length was assessed using the Poznanski-score. The BoneXpert-method was used to determine the Bone Age (BA, > 5 years) and bone mineral density (BMD) of the wrist. These scores were evaluated over time and compared between the treatment arms and mean JADAS10-score using linear mixed models corrected for age and symptom duration.


In 60 patients, 252 radiographs were analysed. Baseline age and symptom duration were different between the arms. No difference in comparison to the healthy reference population was found at baseline for the Poznanski-score (IQR varying from − 0,82; 0.68), nor for BA (varying from − 0.88 to 0.74). Baseline BMD was statistically significantly lower in arm 3 (initial treatment with etanercept and methotrexate) (− 1.48; − 0.68) compared to arm 1 (− 0.84; − 0.04) and arm 2 (− 0.93; 0.15). After treatment to target inactive disease, the Poznanski-scores and the BA remained clinically unchanged, while the BMD in arm 3 improved (p < 0.05 vs arm 1).


Recent-onset JIA patients, treated-to-target aimed at inactive disease, showed no signs of radiographic wrist damage (Poznanski-score, BA or BMD) either at baseline or at follow-up, irrespective of treatment arm. A lower BMD at baseline in arm 3, initially treated with methotrexate and etanercept, improved significantly after treatment.

Trial registration

NTR, NL1504 (NTR1574). Registered 01-06-2009.
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