Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort

Jaime Guzman^{1

2}, Andrew Henrey^{3

4}, Thomas Loughin^{3

4}, Roberta A Berard^{3

4}, Natalie J Shiff^{3

4}, Roman Jurencak^{3

4}, Susanne M Benseler^{3

4}, Lori B Tucker; ReACCh-Out Investigators

Affiliations

¹ From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. jguzman@cw.bc.ca.
² J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia. jguzman@cw.bc.ca.
³ From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.
⁴ J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.

PMID: 27980015
DOI: 10.3899/jrheum.160197

Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort

Jaime Guzman et al. J Rheumatol. 2017 Feb.

. 2017 Feb;44(2):230-240.

doi: 10.3899/jrheum.160197. Epub 2016 Dec 15.

Authors

Affiliations

¹ From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. jguzman@cw.bc.ca.
² J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia. jguzman@cw.bc.ca.
³ From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.
⁴ J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.

PMID: 27980015
DOI: 10.3899/jrheum.160197

Abstract

Objective: We studied an inception cohort of children with juvenile idiopathic arthritis (JIA) to (1) identify distinct disease courses based on changes over 5 years in 5 variables prioritized by patients, parents, and clinicians; and (2) estimate the probability of a severe disease course for each child at diagnosis.

Methods: Assessments of quality of life, pain, medication requirements, patient-reported side effects, and active joint counts were scheduled at 0, 6, 12, 18, 24, 36, 48, and 60 months. Patients who attended at least 6 assessments were included. Multivariable cluster analysis, r², and silhouette statistics were used to identify distinct disease courses. One hundred candidate prediction models were developed in random samples of 75% of the cohort; their reliability and accuracy were tested in the 25% not used in their development.

Results: Four distinct courses were identified in 609 subjects. They differed in prioritized variables, disability scores, and probabilities of attaining inactive disease and remission. We named them Mild (43.8% of children), Moderate (35.6%), Severe Controlled (9%), and Severe Persisting (11.5%). A logistic regression model using JIA category, active joint count, and pattern of joint involvement at enrollment best predicted a severe disease course (Controlled + Persisting, c-index = 0.87); 91% of children in the highest decile of risk actually experienced a severe disease course, compared to 5% of those in the lowest decile.

Conclusion: Children in this JIA cohort followed 1 of 4 disease courses and the probability of a severe disease course could be estimated with information available at diagnosis.

Keywords: JUVENILE ARTHRITIS; PREDICTION; PROGNOSIS; RISK STRATIFICATION; TREATMENT.

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Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort

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Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort

Authors

Affiliations

Abstract

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MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical