Clinical Juvenile Arthritis Disease Activity Score Use in Treat-to-Target Therapy

The clinical Juvenile Arthritis Disease Activity Score (cJADAS) is a useful tool for identifying patients with juvenile idiopathic arthritis (JIA) who are in need of antitumor necrosis factor (anti-TNF) therapy and for guiding treat-to-target therapy, according to a retrospective cohort study published in the Annals of the Rheumatic Diseases.¹

Many rheumatologists use the 2011 American College of Rheumatology clinical practice guidelines (ACR-CPG) for JIA treatment when escalating therapy from methotrexate (MTX) to various disease-modifying antirheumatic drugs, but these guidelines can be complicated for daily practice.² The JADAS was developed to create consistency among physicians in evaluating disease activity and is based on the active joint count, physician global assessment, parent/patient visual analog scale (VAS) of well-being, and the erythrocyte sedimentation rate (ESR).³

Researchers analyzed data from electronic medical records of one institution for patients with oligoarticular JIA (n=39) and polyarticular JIA (n=74) who first started MTX treatment from 2011 to 2015.¹ The researchers found that in their institution, the ACR-CPG decision algorithms were not followed because physicians’ decisions were only aligned with them 0% to 30% of the time.¹ Physicians only escalated therapy in 12% of all decision points, while the ACR-CPG recommended it in 65%. However, physician’s decisions not to escalate therapy were correct 70% to 75% of the time, suggesting that the ACR-CPG may lead to overtreatment with anti-TNFs. In contrast, use of the cJADAS in identifying patients in need of anti-TNF therapy outperformed the ACR-CPG in terms of higher sensitivity, specificity, and accuracy. There appeared to be no benefit of including the ESR, and the performance of the cJADAS decreased when the patient VAS scores had a lower relative contribution.

The researchers concluded that, “The cJADAS incorporates the patient perspective, is very user-friendly and does not need waiting for ESR results before a decision can be made. We therefore believe that the cJADAS can be used for treat-to-target therapy in JIA.”

References

1. Swart JF, van Dijkhuizen EHP, Wulffraat NM, de Roock S. Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis [published online November 14, 2017]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-212104
2. Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res. 2011;63:465-482.
3. Consolaro A, Ruperto N, Bazso A, et al. Development and validation of a composite disease activity score for juvenile idiopathic arthritis.  Arthritis Rheum. 2009;61:658-666.