Defining new clinically derived criteria for high disease activity in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study

Abstract

Objectives To redefine criteria for high disease activity (HDA) in JIA, to establish HDA cut-off values for the 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 (cJADAS10) and to describe the distribution of patients’ disease activity levels based on the JADAS cut-off values in the literature. Methods Data on 305 treatment-naïve JIA patients were collected from nine paediatric units treating JIA. The median parameters of the JADAS were proposed to be the clinical criteria for HDA. The cut-off values were assessed by using two receiver operating characteristics curve–based methods. The patients were divided into disease activity levels based on currently used JADAS cut-off values. Results We proposed new criteria for HDA. At least three of the following criteria must be satisfied in both disease courses: in oligoarthritis, two or more active joints, ESR above normal, physician global assessment (PGA) of disease activity ≥2 and parent/patient global assessment (PtGA) of well-being ≥2; in polyarthritis, six or more active joints, ESR above normal, PGA of overall disease activity ≥4 and PtGA of well-being ≥2. The HDA cut-off values for JADAS10 (cJADAS) were ≥6.7 (6.7) for oligoarticular and ≥15.3 (14.1) for polyarticular disease. The distribution of the disease activity levels based on the JADAS cut-off values in the literature varied markedly based on which cut-offs were used. Conclusion New clinically derived criteria for HDA in JIA and both JADAS and cJADAS cut-off values for HDA were proposed.

Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

“…The population in our work defining CID, LDA and MDA cut-offs20 is completely different from the one in the present work. Regarding the HDA cut-offs 13 out of 14 patients with HDA in the present work are also contributing in the work where we define clinical criteria for HDA 13. In the work defining clinical criteria for HDA, we used the patient’s first visit13 and in this work we used the patient’s most recent visit.…”

“…We divided patients into four groups based on disease activity levels: CID according to the Wallace preliminary criteria,7 LDA and MDA according to Beukelman et al ,10 and HDA according to Backström et al 13. At the time we started our first study on JADAS cut-off values in January 2013, no other clinical definition for MDA or HDA existed but the Beukelman’s definition 10.…”

“…Nevertheless, to assess the meaning of a single JADAS score might be cumbersome. Thus, cut-off values of JADAS,12 13 18–20 and cJADAS,13 17 19 20 have been established for disease activity levels. Some variation exists in the proposed cut-off values since different references have been used 9 11 12 15 17.…”

“…Recently, we established the JADAS10 and cJADAS10 intervals for the Wallace preliminary criteria of CID7 and LDA and MDA according to Beukelman et al 10 20 and HDA according to Backström et al 13. These JADAS10 cut-off values needed validation.…”

“…The aim was to validate the previously established JADAS10 and cJADAS10 cut-off values13 20 and compare them with the cut-off values suggested by Consolaro et al 12 17–19…”