Sat0669 discriminant Ability of the Parent Version of the Juvenile Arthritis Disease Activity Score in a Large Multination Cohort of Patients With Juvenile Idiopathic Arthritis

Abstract

Background: The assessment of disease activity plays a pivotal role in the management of children with juvenile idiopathic arthritis (JIA). Most recent recommendations require that parents' and children's perception is incorporated in the evaluation of the disease course and of effectiveness of therapeutic interventions. A new disease activity tool, named parent Juvenile Arthritis Disease Activity Score (parJADAS) and based only on parent-centered outcome measures, is currently under development (1). Objectives: To demonstrate, in a large multinational dataset of JIA patients, the discriminant ability of the parJADAS. Methods: The parJADAS includes 4 measures: 1) parent assessment of disease activity; 2) assessment of pain intensity; 3) proxy assessment of joint disease; 4) assessment of morning stiffness (MS). Disease activity and pain are assessed on a 21-numbered circle VAS (0 = best and 10 = worst). The active joint count is based on the count of any swollen or painful joint, irrespective of its type, up to a maximum of 10 joints. MS duration is assessed on a Likert scale, ranging from no MS (0 points) to > 2 hours of MS (10 points). Validation was conducted on a dataset of 8,656 children with JIA from 49 countries, enrolled in the study of Epidemiology, treatment and Outcome of Childhood Arthritis (2), who had all the variables included in the parJADAS available. Discriminant ability was evaluated by comparing parJADAS levels (median, [IQR]) among patients with inactive disease (ID), low disease activity (LDA), moderate disease activity (MDA), and high disease activity (HDA) according to the cJADAS10; patients in remission, continued activity, or flare according to the attending physician; patients whose parents were satisfied or not with current disease state. To assess the possible influence of the articular and extra-articular damage on the parJADAS, the levels of the score in patients with or without damage (Juvenile Arthritis Damage Index > 0) were compared. For this analysis, only subjects in inactive disease and with at least 2 years of disease course were considered (n = 2,423). Results: The levels of parJADAS in patients in ID, LDA, MDA, and HDA were 0.

Clinical Epidemiological Studies for Improving Patient Care in Juvenile Idiopathic Arthritis

“…Computer adaptive testing has already been studied in JIA for the Patient-Reported Outcomes Measurement Information System (PROMIS) measures 75 . A new disease activity score based on parent-centred outcome measures, the parent JADAS, is currently under development and preliminary results have indicated excellent discriminative and predictive ability 76 . The parent JADAS could therefore be a reliable tool for remote disease monitoring.…”