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  • How common is clinically inactive disease in a prospective cohort of patients with juvenile idiopathic arthritis? The importance of definition

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Clinical and epidemiological research
Extended report
How common is clinically inactive disease in a prospective cohort of patients with juvenile idiopathic arthritis? The importance of definition
  1. Stephanie J W Shoop-Worrall1,2,
  2. Suzanne M M Verstappen1,
  3. Eileen Baildam3,
  4. Alice Chieng4,
  5. Joyce Davidson5,6,
  6. Helen Foster7,8,
  7. Yiannis Ioannou9,
  8. Flora McErlane7,
  9. Lucy R Wedderburn9,10,
  10. Wendy Thomson2,11,
  11. Kimme L Hyrich1,2
  1. 1 Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  2. 2 NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
  3. 3 Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  4. 4 Royal Manchester Children's Hospital, Manchester, UK
  5. 5 The Royal Hospital for Children, Glasgow, UK
  6. 6 The Royal Hospital for Sick Children, Edinburgh, UK
  7. 7 Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  8. 8 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  9. 9 Arthritis Research UK Centre for Adolescent Rheumatology, GOS Institute of Child Health, University College London, London, UK
  10. 10 Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
  11. 11 Arthritis Research UK Centre for Genetics and Genomics, The University of Manchester, Manchester, UK
  1. Correspondence to Professor Kimme L Hyrich, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 2.800 Stopford Building, Oxford Road, Manchester M13 9PT, UK; Kimme.hyrich{at}manchester.ac.uk

Abstract

Objectives Many criteria for clinically inactive disease (CID) and minimal disease activity (MDA) have been proposed for juvenile idiopathic arthritis (JIA). It is not known to what degree each of these criteria overlap within a single patient cohort. This study aimed to compare the frequency of MDA and CID across different criteria in a cohort of children with JIA at 1 year following presentation.

Methods The Childhood Arthritis Prospective Study recruits children at initial presentation to paediatric or adolescent rheumatology in seven UK centres. Children recruited between October 2001 and December 2013 were included. The proportions of children with CID and MDA at 1 year were calculated using four investigator-defined and eight published composite criteria. Missing data were accounted for using multiple imputation under different assumptions.

Results In a cohort of 1415 children and adolescents, 67% patients had no active joints at 1 year. Between 48% and 61% achieved MDA and between 25% and 38% achieved CID using published criteria. Overlap between criteria varied. Of 922 patients in MDA by either the original composite criteria, Juvenile Arthritis Disease Activity Score (JADAS) or clinical JADAS cut-offs, 68% were classified as in MDA by all 3 criteria. Similarly, 44% of 633 children with CID defined by either Wallace's preliminary criteria or the JADAS cut-off were in CID according to both criteria.

Conclusions In a large JIA prospective inception cohort, a majority of patients have evidence of persistent disease activity after 1 year. Published criteria to capture MDA and CID do not always identify the same groups of patients. This has significant implications when defining and applying treat-to-target strategies.

  • Juvenile Idiopathic Arthritis
  • Disease Activity
  • Outcomes research

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/annrheumdis-2016-210511

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    Footnotes

    • Handling editor Tore K Kvien

    • Correction notice This article has been corrected since it published Online First. Figure 1 and the it's legend have been corrected.

    • Twitter Follow Stephanie Shoop-Worrall @sshoopworrall

    • Contributors Study concept and design: all. Statistical analysis and interpretation of data: SJWS-W, SMMV, KLH. Drafting of manuscript: all. SJWS-W and KLH had full access to data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research of the Department of Health.

    • Funding Medical Research Council (MR/K501311/1), Arthritis Research UK (20164, 20380, 20542) and National Institute for Health Research.

    • Competing interests None declared.

    • Ethics approval Northwest Multicentre Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The Childhood Arthritis Prospective Study dataset is open to third-party data access requests. For more information, please visit http://www.research.bmh.manchester.ac.uk/Musculoskeletal/research//CfE/caps.

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