Association Between Patient-Reported Outcomes and Treatment Failure in Juvenile Idiopathic Arthritis

Abstract

Objective: Children with juvenile idiopathic arthritis (JIA) frequently exhibit symptoms months before diagnosis. The aims of this study were to assess whether baseline patient-reported outcomes (PROs) are associated with changes in JIA pharmacotherapy treatment and whether symptom duration prior to JIA diagnosis is associated with disease activity scores over time.

Methods: This is a retrospective cohort study of patients with an incident diagnosis of JIA. Patient-reported symptom duration, pain, energy, disease activity, sleep, anxiety, and depression screenings, as well as provider-reported disease activity and joint count, were collected during routine clinical care. Cox proportional hazards evaluated PROs, disease activity scores, and symptom duration with initial medication failure within 9 months of diagnosis. Multivariate mixed effects linear regression evaluated the association of symptom duration with disease activity scores.

Results: There were 58 children (66% female, 35% oligoarticular JIA) in the cohort. Nearly half of patients failed initial therapy within 9 months. Unadjusted analysis showed that higher energy (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.69-0.99; P = 0.04) and longer symptom duration (HR: 0.96; 95% CI: 0.93-0.99; P = 0.03) at diagnosis were protective against medication failure. Adjusted analysis showed that symptom duration prior to diagnosis was protective against medication failure (HR: 0.95; 95% CI: 0.92-0.99; P = 0.02); there was no association between medication failure and pain, psychiatric symptoms, or disease activity scores. There was a positive association with longer symptom duration and higher disease activity at 30 and 60 days, but this was not sustained.

Conclusion: Higher energy levels and longer symptom duration are protective against initial JIA treatment failures. Initial treatments informed by patient-reported data could lead to more successful outcomes by changes in treatment paradigms.

Figure 1

Kaplan‐Meier survival estimates stratified by baseline patient‐reported energy, pain, disease activity, and symptom duration. (A) Low and high energy levels are defined as less than 7 and as greater than or equal to 7, respectively. (B) Low and high pain levels are defined as less than 3 and as greater than or equal to 3, respectively. (C) Low and high disease activity scores are defined as initial cJADAS‐10 scores of greater than or equal to 8.5 and as less than 8.5, respectively. (D) Symptom duration was stratified at 6 months. cJADAS‐10, Clinical Juvenile Arthritis Disease Activity Score‐10.