The association between ethnicity, socioeconomic position and outcomes following initiation of methotrexate in Juvenile Idiopathic Arthritis

Mr Richard Beesley is studying for his PhD at the University of Manchester. He talks through his recent research using UK JIA Biologics Register data, which looks at if children from different ethnic groups have different disease activity after treatment with methotrexate.

 What is already known?

Around 1 in 1600 children and young people are diagnosed with juvenile idiopathic arthritis (JIA). Previous research suggests that there may be differences in the proportion of children diagnosed with JIA between different ethnic groups. We know that early diagnosis and prompt treatment can lead to better outcomes, and that delays may have impacts on the severity of the condition.

Many children with JIA start a medication called methotrexate. Whilst this is an effective medication for many, it is not effective for everyone that takes it. When methotrexate is not effective, children usually move to another medication, sometimes alongside the methotrexate.

In other health conditions, ethnic group and socioeconomic position have been associated with health outcomes.

Before this study, we didn’t know if there were differences in levels of disease activity or how long someone kept taking methotrexate between children of different ethnic groups and socioeconomic backgrounds.

What was discovered?

This analysis used data from the UK JIA Biologics Register. A total of 993 children and young people who started methotrexate for their JIA (and who were not taking other medications at the same time) were included.

We looked at the levels of disease activity (which are recorded in regular clinic appointments) when they started treatment and after 6 months. These improved for most children. There was no difference between ethnic groups or socioeconomic groups.

We also looked at how many children were still taking methotrexate after 12 months. We found that around 2 in every 3 children were still taking methotrexate (without other medications) after 12 months (61% of White children, 64% of Asian children, 65% of Black children, and 67% of children of mixed ethnicity). The likelihood of stopping methotrexate was similar between ethnic groups and socioeconomic groups. Of those who were no longer taking methotrexate without other medications after 12 months, around 5% achieved remission, 41% stopped taking methotrexate for other reasons, and 54% continued taking methotrexate alongside another medication. This was similar for all ethnic groups.

Why is this important / what is the benefit to patients?

Overall, it appears that disease activity improved for most children and young people with JIA in the first six months after starting treatment with methotrexate.

It is reassuring that there is no evidence that this differed by ethnicity or socioeconomic position.

However, methotrexate is just one part of treatment for children and young people with JIA, so further work is underway to investigate whether there are differences between ethnic group or socioeconomic position for other JIA treatments.

 Should you wish to read this scientific paper in full, the text can be found online here: https://www.sciencedirect.com/science/article/pii/S3050708125000837

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