THU0580 The acr recommendations for jia in daily clinical practice: are they followed or would treat-to-target therapy lead to better results?

Background What factors drive the physician decision to escalate to anti-TNF therapy 3 and 6 months after start of methotrexate (MTX) in both persisting oligoarthritis (OJIA) and polyarticular course (PJIA) juvenile idiopathic arthritis. Objectives Are the escalation-decisions in accordance with the ACR JIA treatment recommendations (ACR-CPG)1 and if not, what factors drive these decisions. How does it perform as a “prognostic” test to predict failure when not escalated. Could the clinical Juvenile Arthritis Disease Activity Score (cJADAS) be used instead. What is the value of the patient-VAS in the ACR-CPG, the physician decision and in the cJADAS. Methods Monocentric retrospective cohort study analysing all OJIA and PJIA patients starting MTX for the first time between 2011 and 2016. Results The ACR-CPG is mostly not followed and implementation would increase the anti-TNF-use from 12.0% to 65.1%. However, the physician decision not to escalate was now correct in 70%–75%, therefor implementation results in an overuse of anti-TNF. Some items of the ACR-CPG were non-discriminatory. The use of cJADAS in predicting failure if not escalated outperformed the ACR-CPG with a much higher sensitivity and specificity for the OJIA and PJIA group respectively. The omission of the patient-VAS-scores resulted in a substantial decrease of the identification of patients failing to respond without escalation. Conclusions The ACR-CPG not only is too complicated to be applicable in clinical practice, it also fails to identify those patients really in need of escalation to anti-TNF. The cJADAS can be used instead since this is user-friendly, does not require waiting for ESR results and performs better than the ACR-CPG. The patient-VAS is a critical item for the decision to escalate. Reference [1] Beukelman T, et al. 2011American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken)2011;63:465–82. Disclosure of Interest None declared