Evaluation of response to methotrexate by a functional index in juvenile chronic arthritis

Abstract

In juvenile chronic arthritis (JCA) the indices of disease activity, such as joint swelling, pain, tenderness, and limitation of motion, may poorly correlate with the degree of functional impairment. Since the improvement of functional capacity is one of the main objectives of treatment, we evaluated the effect of methotrexate (MTX) in 29 children with JCA by assessing both the articular indices and a functional status measure. After 6 months of therapy, 15 of the 29 patients had a significant (> or = 50%) reduction in the number of joints with active arthritis and/or the articular severity score and were then judged as responders, while 14 did not respond to MTX. In the responder group, the median functional index score decreased from 17 (range: 13-27) at baseline to 13 (range: 13-15) at 6 months (p < 0.001); the median score of the non-responder group was 20 both at baseline and at 6 months (ranges: 14-27, and 13-36, respectively). These results show an improvement of functional impairment in those patients who respond to MTX according to the conventional indices of articular inflammation.

A longitudinal analysis of physical functional disability over the course of juvenile idiopathic arthritis

“…In the years prior to 1994 (when the C-HAQ was published), functional ability was measured using either the modified Lee Index18 or the Juvenile Arthritis Functional Assessment Report (JAFAR) 19. In order to standardise scores from all functional ability tools, scores from the modified Lee Index and the JAFAR were proportionally converted to the 0–3 scale of the C-HAQ.…”

The magnitude of early response to methotrexate therapy predicts long-term outcome of patients with juvenile idiopathic arthritis

“…The following baseline clinical and radiographic assessments were also recorded: physician’s global assessment of the overall disease activity (physician global assessment) measured on a 10-cm visual analogue scale (VAS; 0 = no activity, 10 = maximum activity); parent’s global assessment of the child’s overall well-being on a 10-cm VAS (0 = very good, 10 = very poor); count of joints with active disease (ie, joints with swelling or, if no swelling was present or detectable, with restricted motion and either pain upon movement or tenderness) and count of joints with restricted motion;19 functional ability assessment through the Italian version of the Childhood Health Assessment Questionnaire (C-HAQ)20 (0 = best, 3 = worst) or, in the years earlier than 1994 (when the C-HAQ was published), through the Modified Lee Index21 or the Juvenile Arthritis Functional Assessment Report (JAFAR)22 (we previously found a high correlation between these three questionnaires when administered to the same patient on the same day);19 erythrocyte sedimentation rate (ESR; Westergren method); and Poznanski score of radiographic damage 23 24. Briefly, the Poznanski score is based on the measurement of the radiometacarpal length (RM) and of the length of the second metacarpal bone (M2).…”

Performance of the preliminary definition of improvement in juvenile chronic arthritis patients treated with methotrexate

“…The MD global was scored on a 5 point ordered categorical scale (1=none, 2=mild, 3=moderate, 4=severe, 5=very severe); the parent/patient global was assessed by asking parents to judge their child’s overall well being at six months as compared with baseline according to a 3 point categorical scale (better, same, worse); patients were not asked to self report their overall well being. The functional ability was measured by using either: (1) the Modified Lee Index6; (2) the Juvenile Arthritis Functional Assessment Report (JAFAR)7; (3) the Italian version of the Childhood Health Assessment Questionnaire (CHAQ) disability index 89 In most patients the functional assessment was done by using only one of these instruments, whereas others had their functional status evaluated by more than one method.…”