Determinants of Discordance Between Criteria for Inactive Disease and Low Disease Activity in Juvenile Idiopathic Arthritis

Giancane, Gabriella; Campone, Chiara; Gicchino, Maria Francesca; Alongi, Alessandra; Bava, Cecilia; Rosina, Silvia; Boyko, Yaryna; Martin, Neil; Miedany, Yasser El; Harjaček, Miroslav; Hashad, Soad; Ioseliani, Maka; Burgos‐Vargas, Rubén; Joos, Rik; Scott, Christiaan; Mejbri, Manel; Ayala, Zoilo Morel; Ekelund, Maria; Al‐Abrawi, Safiya; Aiche, M.; Norambuena, Ximena; Melo-Gomes, José; Ruperto, Nicolino; Consolaro, Alessandro; Ravelli, Angelo

doi:10.1002/acr.24415

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…The characteristics of these patients have been reported elsewhere. 14 23 For the present analysis, we selected 9966 patients for whom both PhGA and active joint count (AJC) recorded at the time of clinical assessment were available.…”

Section: Methodsmentioning

confidence: 99%

“…However, some investigators have noticed the tendency of some clinicians not to mark their VAS for global assessment at exactly 0, even on resolution of active disease (ie, when all the other ID criteria are met). 7 13 14 This drawback has led to modify the ID criteria in some recent therapeutic studies by setting the minimum score of the PhGA at 115–17 or even at 2 18. Notably, this phenomenon was seen with the use of the 21-circle VAS,19 which is thought to avoid the aversion to extremes often seen on the horizontal line VAS,20 indicating that it does not depend on the type of VAS used.…”

Section: Introductionmentioning

confidence: 99%

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Drivers of non-zero physician global scores during periods of inactive disease in juvenile idiopathic arthritis

et al. 2022

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ObjectiveTo investigate the frequency in which the physician provides a global assessment of disease activity (PhGA) >0 and an active joint count (AJC)=0 in children with juvenile idiopathic arthritis (JIA) and search for determinants of divergence between the two measures.MethodsData were extracted from a multinational cross-sectional dataset of 9966 patients who had JIA by International League of Associations for Rheumatology criteria, were recruited between 2011 and 2016, and had both PhGA and AJC recorded by the caring paediatric rheumatologist at the study visit. Determinants of discordance between PhGA>0 and AJC=0 were searched for by multivariable logistic regression and dominance analyses.ResultsThe PhGA was scored >0 in 1647 (32.3%) of 5103 patients who had an AJC of 0. Independent associations with discordant assessment were identified for tender or restricted joint count >0, history of enthesitis, presence of active uveitis or systemic features, enthesitis-related or systemic arthritis, increased acute phase reactants, pain visual analogue scale (VAS)>0, and impaired physical or psychosocial well-being. In dominance analysis, tender joint count accounted for 35.43% of PhGA variance, followed by pain VAS>0 (17.72%), restricted joint count >0 (16.14%) and physical health score >0 (11.42%).ConclusionWe found that many paediatric rheumatologists did not mark a score of 0 for patients who they found not to have active joints. The presence of pain in joints not meeting the definition of active joint used in JIA was the main determinant of this phenomenon.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Drivers of non-zero physician global scores during periods of inactive disease in juvenile idiopathic arthritis

et al. 2022

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“…Our study revealed a signi cant increase in patients with minimally active disease over the follow-up. A cross-sectional study showed minimally active disease in 44.8 to 62.4% and in 44.6 to 50.4% of two cohorts of patients with oligoarticular JIA and polyarticular JIA, respectively (19) . In our cohort, we observed minimal disease activity in 80.6% at the nal visit.…”

Section: Discussionmentioning

confidence: 99%

A real-life study of Juvenile Idiopathic Arthritis from two Brazilian Centers of Pediatric Rheumatology

TERRAZAS,

CLEMENTE,

Suárez

et al. 2024

Preprint

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Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood, but its outcomes are still difficult to determine. We aimed to obtain outcome measurements of disease activity, functional capacity, disease damage and therapeutic response, in a one-year follow-up study on a real-life basis.Methods An observational study from an Inception cohort of JIA from two Brazilian Pediatric Rheumatology Centers was conducted for one year. Clinimetric validated outcome measurements were applied over four visits (baseline: Vbaseline, week 12: V12, week 26: V26 and week 52: V52). The multivariable logistic regression was performed to evaluate baseline variables associated with disease activity, minimal disease activity, disease flare, remission on medication and remission off medication at one year of follow-up.Results A total of 127 patients were included in the study. Eighty-three (65.4%) were females, and median time to diagnosis was 6.0 months. The most frequent JIA subtypes were persistent oligoarticular and rheumatoid factor-negative polyarticular, 30.7% each. The clinimetric measurements used to assess disease activity and functional capacity showed significant improvement over the one-year follow-up period (p < 0.001 in both cases) as well as the therapeutic response assessed by the Ped-ACR-30,50,70,90 (p < 0.05). Inactive disease was present in 33% of patients at baseline, vs 67.9% at V52. Remission on medication and off medication was present in 46% and in 11% of patients at V52, respectively. Extra-articular and articular damage were not common at baseline and did not decrease significantly during the period of the study. The presence of active joints at baseline reduced the chance of the patient achieving remission off medication at the last visit by 84% (p = 0.039). Minimal disease activity was present in 80.6% at V52.Conclusion This study showed progressive improvement of several clinimetric outcome measurements and therapeutic response in an inception cohort of JIA patients. The presence of active joints at baseline represented a risk of not achieving remission at last visit. Long-term prospective and multicenter studies are needed to better assess the follow up of JIA and the differences between subtypes in real life.

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“…Studies have shown that the PhGA is not scored homogeneously. 26 27 Currently there are no guidelines on how to score the PhGA or the PaGA.…”

Section: Discussionmentioning

confidence: 99%

Disease activity trajectories from childhood to adulthood in the population-based Nordic juvenile idiopathic arthritis cohort

Rypdal,

Glerup,

Rypdal

et al. 2024

RMD Open

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ObjectivesTo identify long-term disease activity trajectories from childhood to adulthood by using the clinical Juvenile Arthritis Disease Activity Score (cJADAS10) in juvenile idiopathic arthritis (JIA). Second, to evaluate the contribution of the cJADAS10 components and explore characteristics associated with active disease at the 18-year follow-up.MethodsPatients with onset of JIA in 1997–2000 were followed for 18 years in the population-based Nordic JIA cohort. We used a discrete mixture model for longitudinal clustering of the cJADAS10 and its components. We assessed factors potentially associated with higher scores on the patient’s global assessment of well-being (PaGA) by hierarchical clustering and correlation analysis.ResultsFour disease activity trajectories were identified based on the cJADAS10 components among 427 patients. In trajectory-group 2, the PaGA and the physician’s global assessment of disease activity (PhGA) increased significantly during the course, but not the active joint count. The increase in the PaGA was significantly higher than the increases in the PhGA and the active joint count (p<0.0001). A similar pattern was found among all the patients with active disease in the total cohort. Patients with higher PaGA scores had unfavourable scores on several other patient-reported outcomes.ConclusionsWe have identified groups of patients based on long-term disease activity trajectories. In our study the PaGA was the most important driver of disease activity into adulthood assessed by cJADAS10. We need to better understand how our patients interpret global well-being and implement strategies to achieve inactive disease perceived both by the patient and the physician.

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Determinants of Discordance Between Criteria for Inactive Disease and Low Disease Activity in Juvenile Idiopathic Arthritis

Cited by 5 publications

References 19 publications

Drivers of non-zero physician global scores during periods of inactive disease in juvenile idiopathic arthritis

Drivers of non-zero physician global scores during periods of inactive disease in juvenile idiopathic arthritis

A real-life study of Juvenile Idiopathic Arthritis from two Brazilian Centers of Pediatric Rheumatology

Disease activity trajectories from childhood to adulthood in the population-based Nordic juvenile idiopathic arthritis cohort

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