Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus

doi:10.3899/jrheum.180168

. 2019 Feb;46(2):190-197.

doi: 10.3899/jrheum.180168. Epub 2018 Oct 1.

Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus

Alberto Martini^{1

2}, Angelo Ravelli^{3

4}, Tadej Avcin^{3

4}, Michael W Beresford^{3

4}, Ruben Burgos-Vargas^{3

4}, Ruben Cuttica^{3

4}, Norman T Ilowite^{3

4}, Raju Khubchandani^{3

4}, Ronald M Laxer^{3

4}, Daniel J Lovell^{3

4}, Ross E Petty^{3

4}, Carol A Wallace^{3

4}, Nico M Wulffraat^{3

4}, Angela Pistorio^{3

4}, Nicolino Ruperto^{3

4}; Pediatric Rheumatology International Trials Organization (PRINTO)

Affiliations

¹ From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands. albertomartini@gaslini.org.
² A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO. albertomartini@gaslini.org.
³ From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.
⁴ A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO.

PMID: 30275259
DOI: 10.3899/jrheum.180168

Free article

Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus

Alberto Martini et al. J Rheumatol. 2019 Feb.

Free article

. 2019 Feb;46(2):190-197.

doi: 10.3899/jrheum.180168. Epub 2018 Oct 1.

Authors

Affiliations

¹ From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands. albertomartini@gaslini.org.
² A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO. albertomartini@gaslini.org.
³ From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.
⁴ A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO.

PMID: 30275259
DOI: 10.3899/jrheum.180168

Abstract

Objective: To revise the current juvenile idiopathic arthritis (JIA) International League of Associations for Rheumatology (ILAR) classification criteria with an evidence-based approach, using clinical and routine laboratory measures available worldwide, to identify homogeneous clinical groups and to distinguish those forms of chronic arthritis typically seen only in children from the childhood counterpart of adult diseases.

Methods: The overall project consists of 4 steps. This work represents Step 1, a Delphi Web-based consensus and Step 2, an international nominal group technique (NGT) consensus conference for the new provisional Pediatric Rheumatology International Trials Organization JIA classification criteria. A future large data collection of at least 1000 new-onset JIA patients (Step 3) followed by analysis and NGT consensus (Step 4) will provide data for the evidence-based validation of the JIA classification criteria.

Results: In Step 1, three Delphi rounds of interactions were implemented to revise the 7 ILAR JIA categories. In Step 2, forty-seven questions with electronic voting were implemented to derive the new proposed criteria. Four disorders were proposed: (a) systemic JIA; (b) rheumatoid factor-positive JIA; (c) enthesitis/spondylitis-related JIA; and (d) early-onset antinuclear antibody-positive JIA. The other forms were gathered under the term "others." These will be analyzed during the prospective data collection using a list of descriptors to see whether the clustering of some of them could identify homogeneous entities.

Conclusion: An international consensus was reached to identify different proposed homogeneous chronic disorders that fall under the historical term JIA. These preliminary criteria will be formally validated with a dedicated project.

Keywords: ANTINUCLEAR ANTIBODIES; AUTOIMMUNE DISEASES; JUVENILE IDIOPATHIC ARTHRITIS.

PubMed Disclaimer

Comment in

Juvenile Idiopathic Arthritis: An Idea Whose Time Has Gone?
Beukelman T, Nigrovic PA. Beukelman T, et al. J Rheumatol. 2019 Feb;46(2):124-126. doi: 10.3899/jrheum.180922. J Rheumatol. 2019. PMID: 30710000 No abstract available.

Cited by

Illness Uncertainty in Parents of Children with Juvenile Idiopathic Arthritis.
Pearce C, Newman S, Mulligan K. Pearce C, et al. ACR Open Rheumatol. 2021 Apr;3(4):250-259. doi: 10.1002/acr2.11238. Epub 2021 Mar 12. ACR Open Rheumatol. 2021. PMID: 33710801 Free PMC article.
Treatment of non-systemic juvenile idiopathic arthritis.
Shenoi S, Horneff G, Aggarwal A, Ravelli A. Shenoi S, et al. Nat Rev Rheumatol. 2024 Mar;20(3):170-181. doi: 10.1038/s41584-024-01079-8. Epub 2024 Feb 6. Nat Rev Rheumatol. 2024. PMID: 38321298 Review.
Neuropsychological functioning and academic abilities in patients with juvenile idiopathic arthritis.
Granjon M, Rohmer O, Doignon-Camus N, Popa-Roch M, Pietrement C, Gavens N. Granjon M, et al. Pediatr Rheumatol Online J. 2021 Apr 14;19(1):53. doi: 10.1186/s12969-021-00541-1. Pediatr Rheumatol Online J. 2021. PMID: 33853628 Free PMC article.
Using Digital Health Technologies to Monitor Pain, Medication Adherence and Physical Activity in Young People with Juvenile Idiopathic Arthritis: A Feasibility Study.
Butler S, Sculley D, Santos D, Girones X, Singh-Grewal D, Coda A. Butler S, et al. Healthcare (Basel). 2024 Feb 2;12(3):392. doi: 10.3390/healthcare12030392. Healthcare (Basel). 2024. PMID: 38338277 Free PMC article.
Diagnostic accuracy of serum calprotectin measured by CLIA and EIA in juvenile idiopathic arthritis: a proof-of-concept study.
Codes-Méndez H, Magallares-López B, Park HS, Mariscal A, Juárez C, Boronat S, Martínez-Martínez L, Corominas H. Codes-Méndez H, et al. Front Pediatr. 2024 Jun 19;12:1422916. doi: 10.3389/fped.2024.1422916. eCollection 2024. Front Pediatr. 2024. PMID: 38962573 Free PMC article.

See all "Cited by" articles

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Substances

Actions
Actions

LinkOut - more resources

Full Text Sources
- Bicocca Open Archive UniMiB(BOA) - Access Free Full Text
- HighWire
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus

Affiliations

Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus

Authors

Affiliations

Abstract

Comment in

Similar articles

Cited by

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Abstract

Comment in

Similar articles

Cited by

Publication types

MeSH terms

Substances

Related information

LinkOut - more resources

Full Text Sources

Medical