Arthritis Therapy Keeps Children in School

Children with juvenile rheumatoid arthritis may miss fewer days of school when treated with abatacept, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

There are several different types of juvenile arthritis. The most common form is juvenile rheumatoid arthritis, also known as juvenile idiopathic arthritis, or JIA. There are several different types of JIA. All cause joint inflammation and begin before the age of 16 years, but otherwise are often associated with distinct symptoms and complications and may require different approaches to treatment.

Chronic pain and physical disability from JIA limit children from participating in daily activities and often cause them to miss school. In addition to the struggle of a child missing several days of school each month due to JIA, parents often miss work and other important activities to care for their children when they are out of school. This can have a great impact on the overall well-being of a family.

In a recent controlled study of abatacept compared to placebo, researchers looked at the number of school days each patient missed in a month and the number of usual work and non-work activity days parents experienced in a month due to their children’s JIA. Finally, researchers looked at the number of days parents had to pay for childcare in order to engage in regular activities in a month and the overall quality of life experienced by both patients and parents during this time.

Researchers followed 190 JIA patients to determine whether activity participation changed in both the patients and their parents following abatacept (Orencia) treatment. Patients received monthly infusions of abatacept (at 10 milligrams per kilograms) for four months during an open-label, lead-in period.

At the beginning of the study, patients missed an average of 4.1 days of school per month. Their parents missed an average of 3.5 days of usual activity, while paying for 1.4 days of childcare per month.

During the four-month lead-in period of the study, researchers noticed a gradual reduction of missed activity days for both patients and their parents. By month four of the lead-in period, patients, including those who had not responded to the therapy, reported an average 1.69 day reduction in days out of school that month, while parents reported a 1.92 day reduction in days of missed activities and a 1.18 day reduction in paid childcare.

After this lead-in period, 123 patients, whose average age was 12.4 years, and who had improved to an ACR Pedi 30 score (a composite measure of symptoms and well being) were then equally divided into two groups to either continue receiving abatacept, or begin receiving placebo during a double-blind withdrawal period.

Those patients who continued receiving abatacept reduced their time out of school by another 1.52 days each month—missing less than one day on average—while those placed on placebo actually increased their number of days out of school by 0.56.