Predictors of poor response to methotrexate in polyarticular-course juvenile idiopathic arthritis: analysis of the PRINTO methotrexate trial

Objectives To determine whether baseline demographic, clinical, articular and laboratory variables predict methotrexate (MTX) poor response in polyarticular-course juvenile idiopathic arthritis. Methods Patients newly treated for 6 months with MTX enrolled in the Paediatric Rheumatology International Trials Organization (PRINTO) MTX trial. Bivariate and logistic regression analyses were used to identify baseline predictors of poor response according to the American College of Rheumatology pediatric (ACR-ped) 30 and 70 criteria. Results In all, 405/563 (71.9%) of patients were women; median age at onset and disease duration were 4.3 and 1.4 years, respectively, with anti-nuclear antibody (ANA) detected in 259/537 (48.2%) patients. With multivariate logistic regression analysis, the most important determinants of ACR-ped 70 non-responders were: disease duration >1.3 years (OR 1.93), ANA negativity (OR 1.77), Childhood Health Assessment Questionnaire (CHAQ) disability index> 1.125 (OR 1.65) and the presence of right and left wrist activity (OR 1.55). Predictors of ACR-ped 30 non-responders were: ANA negativity (OR 1.92), CHAQ disability index> 1.14 (OR 2.18) and a parent's evaluation of child's overall wellbeing <= 4.69 (OR 2.2). Conclusion The subgroup of patients with longer disease duration, ANA negativity, higher disability and presence of wrist activity were significantly associated with a poorer response to a 6-month MTX course.We thank the European Union for their support of the project (contract no. BMH4-983531 CA) and the IRCCS G Gaslini. IV was a recipient of European League Against Rheumatism (EULAR) Scientific Training Bursaries. PGM, FS and OA were recipients of a scholarship from the European Union ALFA programme (contract AML/B7-311/97/0666/II-0246-FI). We also acknowledge all remaining colleagues at centres who enrolled patients in the MTX trial. Australia: Kevin J Murray; Belgium: Rik Joos, Carine Wouters; Brazil: Sheila Oliveira, Claudia Saad Magalhaes, Virginia Ferriani; Bulgaria: Dimitrina Mihaylova; Czech Republic: Pavla Dolezalova; Finland: Pekka Lahdenne; Germany: Kirsten Minden; Israel: Riva Brik; Italy: Valeria Gerloni, Maria Alessio, Fabrizia Corona, Fernanda Falcini, Francesco Zulian, Maria Giannina Alpigiani, Elisabetta Cortis, Loredana Lepore, Roberta Galasso; Mexico: Ruben Burgos-Vargas; The Netherlands: Nico Wulffraat, Rebecca ten Cate, RenEe van Soesberger; Norway: Line Asplin, Berit Flato, Marite Rygg; Slovakia: Richard Vesely; Spain: Julia Garcia-Consuegra, Rosa Merino, Immaculada Calvo; Sweden: Boel Andersson-Gare; Switzerland: Rotraud Saurenmann, Marie-Joseph Sauvain; Turkey: Aysin Bakkaloglu, Huri Ozdogan; UK: Eileen Baildam, Joyce Davidson, Helen Foster, Jo Walsh, Ann Hall, Helen Venning, Pat Woo; USA: Phil Hashkes, Yukiko Kimura