Prediction of inactive disease and relapse in oligoarticular juvenile idiopathic arthritis

Sezer, Müge; Aydın, Fatma; Kurt, Tuba; Tekgöz, Nilüfer; Tekin, Zahide Ekici; Karagöl, Cüneyt; Çakar, Nilgün; Acar, Banu

doi:10.1080/14397595.2020.1836788

Cited by 5 publications

(8 citation statements)

References 21 publications

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“…Similarly, for total score, the cutoff was 2 points; thus, even mild synovitis with any other evidence of disease activity was 92% specific for relapse prediction. This was similar to previous literature, 5,13 found synovial hypertrophy at baseline imaging was a predictor of subsequent relapse, with an OR of 3.02. Among the score-based models, those that incorporated abrupt drug withdrawal strategy and higher initial disease burden as predictors of relapse showed statistical significance.…”

Section: Discussionsupporting

confidence: 92%

“…This was also in agreement with the results of prior studies who had reported a higher initial Juvenile Arthritis Disease Activity Score in patients who subsequently had a relapse. 5 However, the results of our study showed that imaging parameters alone performed even better at predicting relapse among children in clinical remission than models that combined imaging and clinical or laboratory variables. In fact, in multivariate regression analysis, it was found that clinical and laboratory parameters including serum markers, number of joints involved, and drug stoppage strategy lost their statistical significance, but imaging parameters including synovitis score and total MRI score were still found to be near statistical significance.…”

Section: Discussionmentioning

confidence: 58%

“…Further, 8 composite models were generated incorporating multiple risk variables in addition to the score parameters, based on results of previous authors, 4,5 as well as preliminary χ 2 analysis. Univariate logistic regression was applied using score as a predictor variable and relapse as the outcome variable.…”

Section: Discussionmentioning

confidence: 99%

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Can Whole-Body Magnetic Resonance Imaging Predict Relapse in Juvenile Idiopathic Arthritis? A Longitudinal Pilot Study

Bhalla,

Bagri,

Jana

et al. 2023

J Clin Rheumatol

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Objective To determine the utility of whole-body magnetic resonance imaging (WB MRI) to predict relapse in children with juvenile idiopathic arthritis (JIA) in clinical remission. Methods Consecutive patients with JIA who fulfilled the Wallace criteria for remission were recruited into this longitudinal pilot study and underwent WB MRI. A radiological score was devised, incorporating synovitis, bone marrow edema, sacroiliitis, enthesitis, and bone erosions. Two readers independently scored the MR data sets. The same score was calculated for both knee joints individually and correlated with outcome for that joint. Score-based models incorporating clinical and laboratory variables were generated. Logistic regression analysis was done to determine predictors for relapse. Receiver operating characteristic curve was drawn for significant variables. Results Twenty-two children (median age, 12 years; interquartile range, 9.5–14.25 years) were included in the final analysis. At 24 months' follow-up, 15 joints in 5 children relapsed; knee was the most common site. Seven knee joints had disease relapse. On univariate analysis, synovitis and total score on WB MRI were significant predictors of relapse at follow-up, with odds ratios of 9.46 (bias-corrected 95% confidence interval, 3.07–29.13) and 2.8 (bias-corrected 95% confidence interval, 1.23–6.39) respectively. Two models, which included a higher number of joints involved at presentation and abrupt drug withdrawal strategy as predictor variables, were also statistically significant (odds ratio, approximately 1.9). On multivariate analysis of the predictors variables in models where p < 0.6, it was found that only synovitis score and total score were near statistical significance (p = 0.06); no clinical or laboratory variables were significant. The areas under the receiver operating characteristic curve for relapse prediction were approximately 0.82, 0.87, 0.79, and 0.81 for synovitis score, total MRI score, and both models, respectively. Conclusion Synovitis on WB MRI is the strongest independent predictor for disease relapse in children with JIA in remission

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 58%

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Can Whole-Body Magnetic Resonance Imaging Predict Relapse in Juvenile Idiopathic Arthritis? A Longitudinal Pilot Study

Bhalla,

Bagri,

Jana

et al. 2023

J Clin Rheumatol

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“…It therefore correlates with “immunological” flogosis, which is not detectable in joint objective examination. Indeed, this biomarker may help to redefine the “target” as an “immunologic and imaging remission” other than a clinical one alone, with possible important prognostic implications [ 9 , 10 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, multivariate models were constructed to analyze the effect of covariates and to fully adjust the association of serum calprotectin with relapse or remission of disease. First, confounders were selected from the literature and were subsequently tested for their association with both the determinant and the outcome or a change in the unadjusted effect estimates of 10% when added to the univariate model [ 35 , 36 , 45 , 46 , 47 , 48 ]. Confounders were included in the final model if they were either associated with determinant and outcome, not in the causal pathway, or if the effect estimate changed by 10% when they were included.…”

Section: Methodsmentioning

confidence: 99%

The Role of Serum Calprotectin in Defining Disease Outcomes in Non-Systemic Juvenile Idiopathic Arthritis: A Pilot Study

d’Angelo

Attanasi²,

Donato³

et al. 2023

IJMS

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Serum calprotectin (MRP8/14) is currently being studied as a promising biomarker of disease activity and outcome in patients with juvenile idiopathic arthritis (JIA) but the data in the literature are conflicting. The aim of our study was to investigate the potential role of serum calprotectin as biomarker of disease activity and flare/remission in a group of nsJIA patients during a follow-up period of 18 months. In this prospective longitudinal study, two groups of patients with ns-JIA (55 active patients and 56 patients in remission according to Wallace’s criteria) and a control group (50 children) were recruited at baseline from January 2020 to September 2021. JIA patients were followed for up to 18 months at four timepoints: 3 months (T1), 6 months (T2), 12 months (T3) and 18 months (T4). At each timepoint, the following were recorded: JADAS27, blood counts, ESR, CRP, albumin, ferritin and serum calprotectin. To illustrate the performance of calprotectin, Kaplan–Meier curves were constructed from baseline to relapse/remission, dichotomizing patients at baseline in positive/negative on the basis progressive calprotectin cut-offs. Associations between baseline factors and relapse were determined using Cox regression models. Multivariate models were constructed to analyze the effect of covariates. Comparing baseline clinical and laboratory data of the three groups (active vs. inactive JIA vs. controls), only serum calprotectin reached statistical significance (active patients vs. inactive (p = 0.0016) and vs. controls (p = 0.0012)). In the inactive group, during the 18 months of follow-up, 30 patients (54.6%) had a relapse. Comparing the baseline data of relapsers vs. non-relapsers, serum calprotectin showed higher levels (p = 0.001) in relapsers. In survival analysis, a log rank test showed significant differences of up to 12 ng/mL (p = 0.045). Multivariate Cox regression confirmed that only baseline calprotectin levels were independently associated with disease recurrence. In the active group, in the 12 months of follow-up, 19 patients (38%) entered remission of the disease. In addition, in this group, the only statistical difference at the baseline was the value of MPR8/14 (p = 0.0001). Log rank test showed significant differences up to 10 ng/mL (p = 0.003). In the multivariate Cox regression, serum calprotectin levels at baseline were independently associated with remission. In conclusion, our study would suggest a dual role for calprotectin in predicting future relapse and treatment response in patients with nsJIA, thus influencing therapeutic decisions and management of these patients during follow up.

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Predictors of Disease Activity in Patients With Juvenile Idiopathic Arthritis at 12 and 24 Months After Diagnosis

Balay‐Dustrude,

Weiss,

Sutton

et al. 2024

ACR Open Rheumatology

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ObjectiveIdentification of characteristics associated with active disease in juvenile idiopathic arthritis (JIA) could inform early disease treatment strategies. This study evaluated characteristics associated with active disease at 12 and 24 months after JIA diagnosis in the era in which biologic disease‐modifying antirheumatic drugs (DMARDs) became available for JIA.MethodsThis single‐center retrospective study from 2004 through 2018 assessed characteristics associated with active nonsystemic categories of JIA at 12 and 24 months after diagnosis. Relative prevalence (RP) of disease activity was evaluated in relation to prespecified characteristics. Using RP, the effect of increasing biologic DMARD availability on these predictors was assessed at 12 months.ResultsA total of 1,151 patients with JIA were included. At 12 months, a 40% to 45% higher point prevalence of active disease was noted in older children (>5 years). Patients with active disease at 3 months had a greater prevalence of active disease at 12 months (RP 1.5, 95% confidence interval [CI] 1.2–1.8) and 24 months (RP 1.3, 95% CI 1–1.6). Compared to oligoarticular JIA, polyarticular RF‐negative, psoriatic, and enthesitis‐related JIA had a greater prevalence of active disease at 12 and 24 months. At 24 months, a greater prevalence of active disease was observed in children ≥10 years. RP of active disease was 25% lower in the late cohort (2013–2018) than in the earliest cohort (2004–2008; RP 0.75, 95% CI 0.62–0.92) when more biologic medications were available, but disease activity predictors were broadly similar over time.ConclusionPatients with JIA with active disease at 12 and 24 months were older at diagnosis, categorized as polyarticular RF‐negative, psoriatic, or enthesitis‐related JIA. Active disease at 3 months after diagnosis was associated with worse outcomes at 12 and 24 months.

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Prediction of inactive disease and relapse in oligoarticular juvenile idiopathic arthritis

Cited by 5 publications

References 21 publications

Can Whole-Body Magnetic Resonance Imaging Predict Relapse in Juvenile Idiopathic Arthritis? A Longitudinal Pilot Study

Can Whole-Body Magnetic Resonance Imaging Predict Relapse in Juvenile Idiopathic Arthritis? A Longitudinal Pilot Study

The Role of Serum Calprotectin in Defining Disease Outcomes in Non-Systemic Juvenile Idiopathic Arthritis: A Pilot Study

Predictors of Disease Activity in Patients With Juvenile Idiopathic Arthritis at 12 and 24 Months After Diagnosis

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