Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: Results of a Canadian multicenter, prospective inception cohort study

Abstract

Objective. To determine early predictors of 6-month outcomes in a prospective cohort of patients with juvenile idiopathic arthritis (JIA).Methods. Patients selected were those enrolled in an inception cohort study of JIA, the Research in Arthritis in Canadian Children Emphasizing Outcomes Study, within 6 months after diagnosis. The juvenile rheumatoid arthritis core criteria set and quality of life measures were collected at enrollment and 6 months later. Outcomes evaluated included inactive disease, Juvenile Arthritis Quality of Life Questionnaire (JAQQ) scores, and Childhood Health Assessment Questionnaire (C-HAQ) scores at 6 months. Results. Thirty-three percent of patients had inactive disease at 6 months. Onset subtype and most baseline core criteria set measures correlated with all 3 outcomes. Relative to oligoarticular JIA, the risks of inactive disease were lower for enthesitis-related arthritis, polyarthritis rheumatoid factor (RF)-negative JIA, and polyarthritis RF-positive JIA, and were similar for psoriatic arthritis. In multiple regression analyses, the baseline JAQQ score was an independent predictor of all 3 outcomes. Other independent baseline predictors included polyarthritis RF-negative and systemic JIA for inactive disease; C-HAQ score and polyarthritis RF-positive JIA for the 6-month C-HAQ score; and active joint count, pain, and time to diagnosis for the 6-month JAQQ score. Conclusion. Clinical measures soon after diagnosis predict short-term outcomes for patients with JIA. The JAQQ is a predictor of multiple outcomes. Time to diagnosis affects quality of life in the short term.

Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort

“…Nevertheless, despite the measured improvements, 50% or more of the patients in each subtype with the exception of patients with oligoarthritis and those in the undifferentiated arthritis group continued to have active arthritis. We recently reported that 33% of the patients in our JIA cohort achieved clinically inactive disease 6 months after enrollment (46% of patients with oligoarticular onset, 19% with RF-negative polyarthritis, 8% with RF-positive polyarthritis, 27% with systemic arthritis, 35% with PsA, 19% with ERA, and 32% with undifferentiated arthritis) (18), using a definition based on that of Wallace et al (26). Altogether, our findings suggest significant improvement but persistent low-grade activity in the short term for many newly diagnosed patients with JIA who are managed with current treatment strategies.…”

“…For the present report, a subset of patients from the ReACCh-Out Study was selected based on enrollment within 6 months after diagnosis, and completion of both enrollment and 6-month followup assessments between January 1, 2005 and December 31, 2007, as described previously (18). A maximum time interval of 6 months between diagnosis and enrollment was chosen in order to select patients close to diagnosis with limited exposure to medications at enrollment and yet obtain a reasonable sample size.…”

“…ILAR JIA subtype diagnoses at enrollment were assigned as previously described (18). Briefly, JIA-onset subtype diagnoses provided by the site investigators were reviewed for compliance with the ILAR criteria.…”

“…We have recently described a 33% rate of inactive disease at 6 months after enrollment in an inception cohort of patients with JIA managed with current treatment approaches; however, the spectrum of improvement other than inactive disease status was not examined in that study (18). The ACR pediatric definitions of improvement, the ACR Pediatric 30 (Pedi 30), 50, and 70 criteria responses, based on the degree of improvement in a set of 6 core measures of disease activity, offer a uniform system of reporting improvement in disease, and have been used mainly in patients with juvenile rheumatoid arthritis (JRA) diagnosed by ACR (formerly the American Rheumatism Association) criteria or systemic, oligoarthritis, and polyarthritis subtypes of JIA diagnosed by ILAR criteria (10,16,17,19 -22).…”

Subtype frequencies, demographic features, and remission rates in juvenile idiopathic arthritis - 265 cases from a Turkish center

“…1 It was observed that while oligoarthritis is the most common subtype in Europe and North America, enthesitis related arthritis is the most common subtype in Asia and Middle Eastern countries. 1,6,7,8,9 The cause and pathogenesis of JIA is still unclear and it is thought that the pathogenesis of each subtype is multifactorial and possibly triggered by environmental stimuli in a genetically susceptible host. Geographical differences in JIA subtype frequencies seem to be supporting this idea and many studies are focusing on the interactions between immune system and microbiome of the gut.…”