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. 2017 Aug;76(8):1381-1388.
doi: 10.1136/annrheumdis-2016-210511. Epub 2017 Apr 7.

How common is clinically inactive disease in a prospective cohort of patients with juvenile idiopathic arthritis? The importance of definition

Stephanie J W Shoop-Worrall  1   2 , Suzanne M M Verstappen  1 , Eileen Baildam  3 , Alice Chieng  4 , Joyce Davidson  5   6 , Helen Foster  7   8 , Yiannis Ioannou  9 , Flora McErlane  7 , Lucy R Wedderburn  9   10 , Wendy Thomson  2   11 , Kimme L Hyrich  1   2
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How common is clinically inactive disease in a prospective cohort of patients with juvenile idiopathic arthritis? The importance of definition

Stephanie J W Shoop-Worrall et al. Ann Rheum Dis. 2017 Aug.

Erratum in

Abstract

Objectives: Many criteria for clinically inactive disease (CID) and minimal disease activity (MDA) have been proposed for juvenile idiopathic arthritis (JIA). It is not known to what degree each of these criteria overlap within a single patient cohort. This study aimed to compare the frequency of MDA and CID across different criteria in a cohort of children with JIA at 1 year following presentation.

Methods: The Childhood Arthritis Prospective Study recruits children at initial presentation to paediatric or adolescent rheumatology in seven UK centres. Children recruited between October 2001 and December 2013 were included. The proportions of children with CID and MDA at 1 year were calculated using four investigator-defined and eight published composite criteria. Missing data were accounted for using multiple imputation under different assumptions.

Results: In a cohort of 1415 children and adolescents, 67% patients had no active joints at 1 year. Between 48% and 61% achieved MDA and between 25% and 38% achieved CID using published criteria. Overlap between criteria varied. Of 922 patients in MDA by either the original composite criteria, Juvenile Arthritis Disease Activity Score (JADAS) or clinical JADAS cut-offs, 68% were classified as in MDA by all 3 criteria. Similarly, 44% of 633 children with CID defined by either Wallace's preliminary criteria or the JADAS cut-off were in CID according to both criteria.

Conclusions: In a large JIA prospective inception cohort, a majority of patients have evidence of persistent disease activity after 1 year. Published criteria to capture MDA and CID do not always identify the same groups of patients. This has significant implications when defining and applying treat-to-target strategies.

Keywords: Disease Activity; Juvenile Idiopathic Arthritis; Outcomes research.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Per cent patient overlap between outcome criteria. (A) Zero on the PGA versus PGE, (B) CID JADAS10 versus cJADAS10, (C) CID Wallace's preliminary criteria versus JADAS10 and (D) MDA Magni-Manzoni, JADAS10 and cJADAS10. For each figure, percentages are out of all children who satisfied at least one of the criteria displayed. ESR, erythrocyte sedimentation rate; cJADAS: clinical JADAS excluding ESR; CID, clinically inactive disease; JADAS10, Juvenile Arthritis Disease Activity Score in 10 joints; MDA, minimal disease activity.
Figure 2
Figure 2
Per cent of patients with juvenile idiopathic arthritis (JIA) who had achieved CID and MDA states at 1 year following presentation. CID, clinically inactive disease; MDA, minimal disease activity; JADAS, Juvenile Arthritis Disease Activity Score; cJADAS, clinical JADAS; RF, rheumatoid factor.
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Comment in

References

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