Applying clinical Juvenile Arthritis Disease Activity Score criteria to identify clinically inactive disease in patients with juvenile idiopathic arthritis (JIA) resulted in patients with better long-term functional activity and psychosocial health outcomes, compared with patients whose disease state was assessed using Wallace’s preliminary criteria, according to recent research from the multicenter Childhood Arthritis Prospective Study.
“A challenge is in understanding how best to apply these results in the clinical setting,” wrote Stephanie J.W. Shoop-Worrall of the Arthritis Research UK Centre for Epidemiology at the University of Manchester (England) and her coauthors. “As achievement of CID [clinically inactive disease] according to cJADAS10 [clinical Juvenile Arthritis Disease Activity Score assessed in 10 joints] was associated with equivalent or superior outcomes to Wallace’s preliminary criteria and it is more feasible to complete in clinical practice, due to containing only three routinely collected components, one could argue that this is likely to be a superior treatment target for application in clinical practice.”
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Investigators applied the cJADAS10 to determine MDA, while CID was assessed using both cJADAS10 and Wallace’s preliminary criteria at 1-year follow-up. Children were categorized based on whether they achieved CID according to cJADAS10 only, whether they did so according to Wallace’s preliminary criteria only, whether they did so according to both cJADAS10 and Wallace’s preliminary criteria, or whether they did not achieve CID according to either; they also were categorized based on whether they achieved MDA but not CID according to cJADAS10. Researchers examined patient function, limited joints, and psychosocial health, as well as annual pain between 1-year and 5-year follow-up. The results were recently published in Arthritis & Rheumatology.
“Wallace’s preliminary criteria includes five components, observed or measured by a physician, which must all be absent or in the normal range, but do not include an assessment by the patient or their proxy,” Ms. Shoop-Worrall and her colleagues wrote. “In contrast, the JADAS and cJADAS include fewer overall components, meaning they may be easier to complete in a routine clinical setting, but do include a patient or proxy subjective assessment of patient wellbeing.”
Of the patients analyzed, 68% had oligoarthritis, while 27% had RF-negative and 5% had RF-positive polyarticular JIA. Over half (56%) of patients did not achieve CID, while 21% had achieved CID through both definitions. A further 23% of patients achieved CID in only one definition – 16% of patients according to cJADAS10 and 7% of patients according to Wallace’s preliminary criteria. Patients who achieved CID had significantly increased odds of having no limited joints according to either cJADAS10 (odds ratio, 3.9; 95% confidence interval, 2.5-6.3) or Wallace’s preliminary criteria (OR, 7.5; 95% CI, 2.9-19.2). Patients had better Child Health Questionnaire psychosocial scores when they achieved CID according to either cJADAS10 (coefficient, 5.3; 95% CI, 0.5-10.1) or both cJADAS10 and Wallace’s preliminary criteria (coefficient, 5.5; 95% CI, 2.2-9.5).
When patients’ function was assessed using the Childhood Health Assessment questionnaire, they had significantly increased odds of having no disability recorded when they achieved CID with either cJADAS10 (OR, 4.5; 95% CI, 2.2-9.5) or both criteria (OR 5.2; 95% CI, 2.7-9.9). Patients assessed with Wallace’s preliminary criteria had “no better Child Health Questionnaire psychosocial scores or Childhood Health Assessment questionnaire scores than those with active disease at 1 year.” Most patients who achieved CID also achieved MDA, but 10% of patients reached MDA without achieving CID.