gms | German Medical Science

Background and aim: Rheumatoid arthritis (RA) in children and adolescents (CaA) is similar to adult forms but often progress and consequences are less severe in CaA. Therefore treatment optimization requires differentiation between mild and severe forms.

Drug treatment guidelines for juvenile idiopathic arthritis (JIA) consider these facts and recommend symptomatic treatment (NSAIDs, corticosteroids) and – in severe cases – DMARDs (disease modifying antirheumatic drugs) with methotrexate as first choice. Other DMARDs are not relevant in JIA except for specific cases. But prescriptions for these drugs increased over the last years remarkably. Aim of this analysis was to characterize drug treatment of CaA with RA with focus on DMARDs.

Material and method: Data analysis is based on prescribing data of the statutory health-insurance company GEK (around 375,000–380,000 enrolees aged 0–19 y per year) for the calendar years 2005–2007. RA patients were identified by reimbursement diagnoses (ICD10: M05-M09 and/or M13). Age- and sex-related disease and treatment prevalences including 95% confidence intervals (CI) were calculated.

Results: RA prevalence among 0–19 year old CaA does not relevantly change between 2005 and 2007 (2007:0,58%, 95%CI: 0,56–0,61%). Females are slightly more frequently concerned than males. Among both sexes prevalences increase with age. Only 56% of all CaA with RA receive at least one RA prescription per year with lower proportions in higher agegroups.

Females receive more frequently DMARDs than males. But DMARD treatment is with 8% of less importance among CaA. Methotrexate is the most frequently prescribed DMARD but still relevant proportions receive second and third line DMARDs.

Conclusions: For most of the CaA with RA our results are not contradictory to guidelines regarding drug treatment except for the age group 15–19 years where a deficit in DMARD therapy can be assumed. Although DMARDs are rarely prescribed the proportions of second and third line DMARDs are quite high. Most of them are not approved for children and/or for RA. Drug treatment patterns should be monitored. Further investigations should also focus non-pharmaceutical treatment options.