Improved Outcomes in Juvenile Idiopathic Arthritis Following Antihistamine Treatment in Patients with Concurrent Allergic Rhinitis

Objective: We aim to assess the influence of antihistamines as an adjunctive therapy in children with JIA who also have co-existing mild to moderate AR. Methods: Fifty-two JIA patients with AR were enrolled and consecutively randomized. The control group comprised 26 patients who were treated with methotrexate (MTX) 10-15 mg/m2/week orally for 12 months and enteric-coated diclofenac sodium 0.5-2 mg/kg/day orally for 12 weeks. The test group comprised 26 patients who received adjunctive therapy with oral and intranasal antihistamines for 12 months, in addition to MTX and diclofenac. The responses were evaluated using American College of Rheumatology (ACR) pediatric (Pedi) 30/50/70 criteria, AR score, 27-joint Juvenile Arthritis Disease Activity Score (JADAS-27), and laboratory variables. Results: At 3 and 6 months follow-up, significantly more patients in the antihistamine treatment group achieved ACR Pedi50 and ACR Pedi70 responses(at 3 months, 73.1% to 19.2%, 38.5% to 7.7%; at 6 months, 96.2% to 53.8%, 76.9% to 19.2%, respectively, all p<0.01). In the antihistamine group the AR score correlated with JADAS-27 at baseline, 3 months and 6 months (r=0.946, r=0.909 and r=0.964, respectively). During 12 months of follow-up, there were significantly fewer JIA flares in the antihistamine group (0.8 ± 0.7 vs. 2.2 ± 1.4, p<0.01). Conclusions: JIA patients with concurrent AR who receive effective antihistamine treatment for their AR may have better outcomes in terms of JIA control.