Factors Determining the Use of Systemic Glucocorticoid Treatment and Cumulative Dose During the First Year After Diagnosis of Juvenile Idiopathic Arthritis

Objectives: Systemic glucocorticoids are commonly used as short-term bridging treatment to control disease activity in juvenile idiopathic arthritis (JIA). This study aimed to analyze the factors affecting the use of systemic glucocorticoid treatment and cumulative dose during the first year after JIA diagnosis. Methods: This retrospective study included children who were diagnosed with JIA according to the International League for Rheumatology (ILAR) classification criteria, excluding systemic JIA, and followed up for at least 1 year. All systemic glucocorticoid treatments administered during follow-up were converted to prednisolone-equivalent doses, and the total cumulative dose was calculated for each patient. Results: The study included 164 patients (53% female), of whom 110 (67.1%) received systemic glucocorticoid treatment. Higher baseline Juvenile Arthritis Disease Activity Score-71 (JADAS-71) scores (OR: 1.149, 95% CI: 1.003-1.316, p =0.045) and ankle joint involvement (OR: 5.740, 95% CI: 1.134-29.050, p =0.035) were associated with an increased use of systemic glucocorticoid treatment, while enthesitis-related arthritis (ERA) was associated with a decreased use (OR: 0.132, 95% CI: 0.036-0.487, p =0.002). Ankle involvement (β: 1.434, 95% CI: 0.328-2.539, p =0.012), antinuclear antibody (ANA) positivity (β: 1.232, 95% CI: 0.181-2.283, p =0.022), and higher baseline JADAS-71 scores (β: 0.101, 95% CI: 0.001-0.202, p =0.046) were strongly associated with increased cumulative systemic glucocorticoid dose. Conclusions: To our knowledge, this is the first study to comprehensively evaluate the factors influencing the use of systemic glucocorticoid treatment and cumulative dose in patients with JIA. Our findings emphasize disease subtypes, specific joint involvements, ANA positivity, and disease activities in this regard.