Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis

Abstract

ObjectivesTo assess if the Juvenile Arthritis Disease Activity Score (JADAS71) could be used to correctly identify patients with juvenile idiopathic arthritis (JIA) in need of antitumour necrosis factor therapy (anti-TNF) therapy 3 and 6 months after start of methotrexate (MTX).MethodsMonocentric retrospective cohort study from 2011 to 2015 analysing all patients with oligoarticular JIA (OJIA) (n=39) and polyarticular course JIA (PJIA) (n=74) first starting MTX. Three and 6 months after MTX start, clinical and laboratory features and the 2011 American College of Rheumatology (ACR) JIA treatment recommendations (ACR clinical practice guideline (ACR-CPG)) were compared between groups starting and not starting anti-TNF therapy. The sensitivity and specificity of the ACR-CPG, JADAS71 and the clinical JADAS to identify non-responders after 12 months were calculated.ResultsPhysicians escalated patients with significantly higher physician global assessment, clinical JADAS (cJADAS) and patient Visual Analogue Scale (VAS). The decision not to escalate was correct in 70%–75% as shown by MTX response. The implementation of the ACR-CPG would increase the current anti-TNF use from 12% to 65%. The use of (c)JADAS in identifying patients in need of anti-TNF therapy outperformed the ACR-CPG with a much higher sensitivity, specificity and accuracy. The cJADAS threshold for treatment escalation at month 3 and 6 was >5 and >3 for OJIA and >7 and >4 for PJIA, respectively. The performance of the cJADAS decreased when the patient VAS contribution to the total score was restricted and overall did not improve by adding the erythrocyte sedimentation rate.ConclusionsThe cJADAS identifies patients in need of anti-TNF and is a user-friendly tool ready to be used for treat to target in JIA. The patient VAS is a critical item in the cJADAS for the decision to escalate to anti-TNF.

Treating juvenile idiopathic arthritis to target: recommendations of an international task force

“…The JADAS and cJADAS cut-offs that correspond to CR and LDA in JIA were determined 9 10 60. Recently, the cJADAS was found to be potentially suitable to guide a treat-to-target strategy in JIA 61. During the consensus meeting, there was debate about the relative measurement properties and suitability for the treat-to-target strategy of the various tools.…”

Treating juvenile idiopathic arthritis to target: what is the optimal target definition to reach all goals?

“…Wallace's preliminary criteria capture more objective measures of inflammation, and can be regarded a narrow target [7]. The clinical Juvenile Arthritis Disease Activity Score (cJADAS), through inclusion of a global measure of patient well-being, may also capture other non-inflammatory components of the disease, such as chronic pain and fatigue and is regarded a broader target [4,8]. The Task Force decided not to recommend the use of a specific instrument, leaving the choice to the clinician [1].…”

“…Two studies found evidence in favour of the broader target in T2T strategies. Swart et al concluded that parental overall scores of well-being increased the identification of methotrexate (MTX) non-responders [8]. The omission of the patient visual analogue scale (VAS) wellbeing scores in the cJADAS prognostic test resulted in a decreased identification of MTX non-responders.…”

Biological disease-modifying antirheumatic drugs in juvenile idiopathic arthritis of polyarticular course, enthesitis-related arthritis, and psoriatic arthritis: a consensus statement

“…It has been shown to outperform other activity measurements in predicting the need of escalation to anti-TNF inhibitors. 27 For both oligoarticular arthritis and pcJIA, a score of ≤1 signifies inactive disease.…”