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

Abstract

ObjectivesTo validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts.MethodsIn a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated.ResultsOur earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0–0.5/0.0–0.7, LDA: 0.6–3.8/0.8–5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0–0.7 for CID, 0.8–5.0 for LDA and >5.0 for MDA.ConclusionInternational consensus on JADAS cut-off values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.

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“…The first issue is the lack of a single 'best' target. Although most would agree that clinical inactive disease (CID) or remission is the ultimate target, there are multiple ways in which this disease state can be assessed in the clinical setting [2][3][4][5][6]. Wallace's preliminary criteria capture more objective measures of inflammation, and can be regarded a narrow target [7].…”

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“…Disease severity at presentation was assessed by active joint count and limited range of motion joint count, extra-articular manifestations, presence of uveitis and elevated ESR and CRP. Disease indices, including Physician Global Assessment of disease activity (PGA), clinical Juvenile Arthritis Disease Activity Score 10 (cJADAS10) [ 14 ] and probability of severe disease [ 15 ], were also compared as markers of disease severity at presentation. Parent and patient reported well-being at presentation were compared using the patient pain scale, parent global assessment, Child Health Assessment Questionnaire (CHAQ) score, Juvenile Arthritis Quality of Life Questionnaire (JAQQ) score, and Quality of My Life (QoML) score.…”

Bone Mineral Density and Bone Markers in Juvenile Idiopathic Arthritis Patients

“…The juvenile arthritis disease activity score (JADAS-27) [11] , which consists of the following 4 elements, physician global assessment of disease activity measured on a 0-10 visual analog scale (VAS) where 0 = no activity and 10 = maximum activity, parent/patient global assessment measured on a 0-10 VAS where 0 = very well and 10 = very poor, number of active joints, and erythrocyte sedimentation rate (ESR) normalized to a (0 to 10) scale.…”

“…JADAS 27 = Active joint count + physician global + parent global + ESR. The total JADAS score range from 0-57 [11] .…”