Table 4

Differences (in the rows) between patients who were recommended to escalate to anti-TNF according to the ACR-CPG and those who were not, as well as between patients who were actually escalated and those who were not (in the columns) at both the 3-month and 6-month visits, for patients with PJIA

PJIAACR-CPG recommends anti-TNFP valuePhysician started anti-TNFP value
NoYesNoYes
3 months, N (%)14 (19)44 (59)60 (81)13 (18)
ACR escalation criteria
One of these:
 ≥5 joints0 (0)23 (52)14 (23)10 (77)
 ESR/CRP >ULN0 (0)15 (34)9 (15)6 (46)
 PGA ≥40 (0)11 (25)6 (10)5 (38)
 Patient VAS ≥20 (0)29 (66)20 (33)9 (69)
 ACR and physician correspond14 (100)13 (30)14 (23)13 (100)
 AJC (median, IQR)1.0 (0.0–2.0)5.0 (2.5–6.5)<0.00052.0 (1.0–4.0)7.0 (6.0–8.0)<0.0005
 ΔAJC (median, IQR)5.0 (3.0–9.0)2.0 (−0.5–4.0)0.0023.0 (1.0–5.0)0.0 (−3.0–1.0)0.001
 ESR in mm/hour (median, IQR)7.0 (6.0–14.0)16.0 (7.0–28.0)0.1011.0 (5.0–20.0)20.0 (11.0–31.0)0.045
 PGA (median, IQR)0.7 (0.2–1.5)2.6 (1.5–3.8)<0.00051.5 (0.5–2.5)3.5 (3.0–4.5)<0.0005
 Patient VAS (median, IQR)0.7 (0.1–1.4)4.4 (2.1–5.9)<0.00051.9 (1.0–4.5)5.5 (4.3–6.0)0.005
 cJADAS (median, IQR)2.8 (1.8–4.5)10.4 (8.2–15.0)<0.00056.7 (3.2–8.9)15.0 (14.0–19.0)<0.0005
 ΔcJADAS (median, IQR)9.7 (6.5–14.2)4.2 (0.9–8.9)0.0036.6 (2.2–11.3)2.1 (−1.2–4.4)0.026
6 months, N (%)13 (21)43 (70)53 (72)8 (13)
ACR escalation criteria
One of these:
 ≥1 joint0 (0)39 (91)31 (58)8 (100)
 ESR/CRP >ULN0 (0)16 (37)12 (23)4 (50)
 PGA >00 (0)39 (91)31 (58)8 (100)
 Patient VAS ≥20 (0)18 (42)11 (21)7 (88)
 ACR and physician correspond13 (100)8 (19)13 (25)8 (100)
 AJC (median, IQR)0 (0.0–0.0)2.0 (1.0–3.5)<0.00051.0 (0.0–2.0)6.0 (3.5–7.5)<0.0005
 ESR in mm/hour (median, IQR)6.0 (3.0–15.0)8.0 (5.0–15.0)0.527.0 (3.0–14.0)13.0 (5.5–16.0)0.50
 PGA (median, IQR)0 (0.0–0.0)1.5 (0.9–2.5)<0.00050.7 (0.0–1.5)3.3 (2.4–4.7)<0.0005
 Patient VAS (median, IQR)0.3 (0.0–0.8)1.8 (0.5–4.0)0.0020.7 (0.2–2.0)4.0 (3.2–5.2)0.002
 cJADAS (median, IQR)0.3 (0.0–0.8)6.7 (2.9–10.0)<0.00052.8 (0.8–6.8)12.4 (9.6–14.7)<0.0005
  • Values are numbers (percentages), except where indicated otherwise. Percentages are based on the column totals for 3 and 6 months, respectively. Decreases (Δ) of AJC and cJADAS at the 3-month visit compared with baseline visit. Without correction for missing data, the ACR-CPG recommended escalation to anti-TNF in 59% of all patients with PJIA at 3 months, while only 18% were actually escalated by the physician. At 6 months, only patients not yet escalated (n=61) were analysed. The ACR-CPG recommended escalation to anti-TNF at 6 months in 70% vs only 13% who were actually escalated.

  • Δ (delta), difference compared with baseline; ACR, American College of Rheumatology; ACR-CPG, ACR clinical practice guideline; AJC, active joint count; anti-TNF, antitumour necrosis factor therapy; cJADAS, clinical Juvenile Arthritis Disease Activity Score; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; PJIA, polyarticular course juvenile idiopathic arthritis; PGA, physician global assessment; ULN, upper limit of normal; VAS Visual Analogue Scale.