Clinical Assessment of Juvenile Idiopathic Arthritis: Predicting Unfavorable Long-Term Outcomes

Easy-to-use statistical models have been designed to predict nonachievement of remission off medication, functional disability, and joint damage among children with juvenile idiopathic arthritis (JIA), according to the results of the Nordic cohort study published in Arthritis Research & Therapy.

Investigators from the Nordic Study Group of Pediatric Rheumatology sought to develop prediction rules that might guide early treatment decisions based on baseline clinical indicators of long-term unfavorable outcomes among patients with JIA. Researchers assessed baseline characteristics as predictors of outcomes 8 years after disease onset. There were 4 outcomes evaluated at follow-up: nonachievement of remission off medication; functional disability evaluated using the Childhood Health Assessment Questionnaire (CHAQ); functional disability evaluated using the Child Health Questionnaire Parent form, which yields a physical summary score (PhS) and a psychological summary score; and joint damage assessed using the Juvenile Arthritis Damage Index of articular damage (JADI-A).

A total of 423 children were enrolled in the study. Remission status was available in 410 of these participants, and 59.5% of these children did not achieve remission off medication at the final study visit. Functional disability was reported in 32.7% of children who were assessed by CHAQ and in 20.1% of children assessed by PhS. Joint damage was found in 13.4% of the participants.

The area under the curves in receiver operating characteristic curves were 0.78 (interquartile range [IQR], 0.72-0.82) for nonachievement of remission off medication, 0.73 (IQR, 0.67-0.76) for functional disability assessed by CHAQ, 0.74 (IQR, 0.65-0.80) for functional disability assessed by PhS, and 0.73 (IQR, 0.63-0.76) for joint damage assessed using JADI-A.

The investigators concluded that long-term outcomes among patients with JIA can be predicted with acceptable sensitivity and specificity, using only a few readily available clinical variables. These prediction models may be valuable tools to assist in early treatment decisions regarding the need for disease-modifying antirheumatic drugs, including biologic agents, in this population. They encourage additional testing of their models before the applicability can be generalized and recommended.

follow @RheumAdvisor

Reference

Rypdal V, Arnstad ED, Aalto K, et al; Nordic Study Group of Pediatric Rheumatology (NoSPeR). Predicting unfavorable long-term outcome in juvenile idiopathic arthritis: results from the Nordic cohort study. Arthritis Res Ther. 2018;20(1):91.