Patient-Reported Outcomes Valuable in the Management of Polyarticular Juvenile Idiopathic Arthritis

In patients with polyarticular juvenile idiopathic arthritis (pJIA), compared with Physician Global Health Assessment (PhGA) scores, Patient Global Health Assessment (PtGA) scores and pain scores were found to be strongly associated with each other, increased at the visit prior to a flare, and have a predictive value for the flare, according to results of a report published in Journal of Patient-Reported Outcomes.

Researchers sought to evaluate the discordance between the PtGA, PhGA, and pain scores in patients with pJIA, as well as evaluate whether the PtGA score during disease remission is linked to future pJIA flares.

Researchers conducted a multicenter, prospective National Institutes of Health (NIH)-funded, nested cohort study (ClinicalTrials.gov Identifier: NCT00792233). A total of 137 patients with clinically inactive pJIA were enrolled at tertiary pediatric rheumatology centers in the US. In the initial 6 months, individuals who fulfilled the criteria for clinically inactive disease (CID) at study enrollment were monitored while receiving stable therapy. Among patients who maintained CID for 6 months, treatment with an antitumor necrosis factor (TNF) was discontinued and follow-up occurred for an additional 8 months.

A total of 120 patients in the study had available records of their disease flare status, among whom 63 developed a flare and 57 did not, during the 8-month observation period after discontinuing the anti-TNF agent. Of the 63 participants who developed a flare, 42 had had a study visit immediately prior to the disease flare. Among participants with a visit that occurred immediately prior to the flare, the PtGA, pain, and PhGA scores all increased at the time of the flare.

Study results showed that for every unit increase in PtGA and pain scores, there was a 9% and 23%, respectively, higher likelihood of developing a flare (P =.76 and P =.40, respectively). PtGA scores increased from 0.5 to 2.0 and pain scores increased from 0.6 to 2.3 for all participants with a flare. However, for every unit increase in the PhGA score, a significantly lower likelihood of developing a flare was reported (P =.05). PhGA scores increased from 0.1 at the prior visit to 2.2 at the time of the initial flare. For participants with a visit immediately prior to experiencing a flare, PtGA scores increased from 0.4 to 1.6, and pain scores increased from 0.4 to 1.8.

Overall, study findings indicated that PtGA and pain scores, and not PhGA scores, were increased at the visit prior to flare. In addition, the risk for flare increased with an increase in PtGA and pain scores, while the PhGA scores were inversely related to flare risk.

One of the study limitations included the fact that the analysis was underpowered and did not reach statistical significance. 

Researchers concluded, “These findings highlight the value of patient input in medical care and decision-making, and support the development and use of more sophisticated PROs in the care of patients with JIA.”

Reference

Trachtman R, Issa R, Pan S, Wilson KM, Lovell DJ, Onel KB. The value of the patient global health assessment in polyarticular juvenile idiopathic arthritis: a nested cohort study. J Patient Rep Outcomes. 2021;5(1):50. doi:10.1186/s41687-021-00328-8