1. Definition and Validation of the American College of Rheumatology 2021 Juvenile Arthritis Disease Activity Score Cutoffs for Disease Activity States in Juvenile Idiopathic Arthritis
- Author
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Marco Garrone, Nicolino Ruperto, Alessandra Alongi, Pierre Quartier, Pekka Lahdenne, Violeta Panaviene, Evert Hendrik Pieter van Dijkhuizen, Angelo Ravelli, Alessandro Consolaro, M. Mazzoni, Sarah Ringold, Lidia Rutkowska-Sak, Soamarat Vilaiyuk, Chris Pruunsild, Joost F Swart, Veronika Vargova, Tadej Avcin, Irina Nikishina, Chiara Trincianti, Pavla Dolezalova, Yosef Uziel, HUS Children and Adolescents, and Children's Hospital
- Subjects
medicine.medical_specialty ,Childhood arthritis ,Full Length ,Immunology ,Juvenile ,Arthritis ,Severity of Illness Index ,Juvenile Arthritis Disease Activity Score ,Rheumatology ,Rheumatoid Factor ,Internal medicine ,Epidemiology ,medicine ,Humans ,Immunology and Allergy ,Registries ,Child ,Oligoarthritis ,business.industry ,Arthritis, Juvenile ,medicine.disease ,3121 General medicine, internal medicine and other clinical medicine ,Cohort ,Special Articles ,Polyarthritis ,business - Abstract
Objective To develop and validate new Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) cutoffs to separate the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with oligoarthritis and with rheumatoid factor-negative polyarthritis, based on subjective disease assessment by the treating pediatric rheumatologist. Methods The cutoffs definition cohort was composed of 1,936 patients included in the multinational Epidemiology, Treatment and Outcome of Childhood Arthritis (EPOCA) study. Using the subjective physician rating as an external criterion, 4 methods were applied to identify the cutoffs: mapping, Youden index, 90% specificity, and maximum agreement. The validation cohort included 4,014 EPOCA patients, patients from 2 randomized trials, and 88 patients from the PharmaChild registry. Cutoff validation was conducted by assessing discriminative and predictive ability. Results The JADAS10 cutoffs were 1.4, 4, and 13, respectively, for oligoarthritis and 2.7, 6, and 17, respectively, for polyarthritis. The cJADAS10 cutoffs were 1.1, 4, and 12, respectively, for oligoarthritis and 2.5, 5, and 16, respectively, for polyarthritis. The cutoffs discriminated strongly among different levels of pain and morning stiffness, between patients who were and those who were not prescribed a new medication, and between different levels of improvement in clinical trials. Achievement of ID and MiDA according to the new JADAS cutoffs at least twice in the first year of disease predicted better outcome at 2 years. Conclusion The 2021 JADAS and cJADAS cutoffs revealed good metrologic properties in both definition and validation samples, and are therefore suitable for use in clinical trials and routine practice.
- Published
- 2021