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 OJIA
| OJIA | ACR-CPG recommends anti-TNF | P value | Physician started anti-TNF | P value | ||
| No | Yes | No | Yes | |||
| 3 months, N (%) | 30 (77) | 7 (18) | 36 (92) | 3 (8) | ||
| ACR escalation criteria | ||||||
| One of these: | ||||||
| ≥2 joints | 8 (27) | 4 (57) | 10 (27.8) | 2 (67) | ||
| ESR/CRP >ULN | 6 (20) | 4 (57) | 10 (27.8) | 1 (33) | ||
| PGA ≥3 | 1 (3) | 3 (43) | 2 (5.6) | 2 (67) | ||
| Patient VAS ≥2 | 9 (30) | 5 (71) | 12 (33.3) | 2 (67) | ||
| AND one of these: | ||||||
| Hip/cervical spine | 0 (0) | 1 (14) | 1 (2.8) | 1 (33) | ||
| Damaged joint ≥1 | 0 (0) | 2 (29) | 2 (5.6) | 0 (0) | ||
| Ankle/wrist+>ULN 6 months/ESR >100 | 1 (3) | 4 (57) | 5 (13.9) | 1 (33) | ||
| ACR and physician correspond | 29 (97) | 2 (29) | 31 (86) | 2 (67) | ||
| AJC (median, IQR) | 1.0 (0.0–2.0) | 2.0 (1.0–2.5) | 0.02 | 1.0 (0.0–2.0) | 2.0 (1.5–2.5) | 0.12 |
| ΔAJC (median, IQR) | 1.0 (1.0–2.0) | 0 (0–0) | 0.006 | 1.0 (0.5–2.0) | 0 (0–0) | 0.02 |
| ESR in mm/hour (median, IQR) | 9.0 (5.0–14.0) | 17.0 (4.5–25.5) | 0.39 | 10.0 (5.0–16.5) | 5.0 (4.5–45.5) | 0.95 |
| PGA (median, IQR) | 0.9 (0.0–1.5) | 2.5 (2.1–3.3) | 0.002 | 1.1 (0.0–2.0) | 3.5 (2.8–3.8) | 0.02 |
| Patient VAS (median, IQR) | 1.6 (0.4–3.6) | 2.4 (2.2–4.2) | 0.17 | 1.9 (0.6–3.0) | 5.0 (4.2–5.7) | 0.07 |
| cJADAS (median, IQR) | 3.5 (0.9–5.5) | 7.5 (7.4–8.7) | 0.02 | 4.3 (1.5–7.0) | 9.2 (8.7–9.7) | 0.03 |
| ΔcJADAS (median, IQR) | 3.7 (1.8–5.3) | 2.4 (0.4–4.8) | 0.46 | 3.7 (1.7–5.3) | 1.7 (0.4–2.9) | 0.30 |
| 6 months, N (%) | 34 (94) | 1 (3) | 32 (89) | 4 (11) | ||
| ACR escalation criteria | ||||||
| Three of these: | ||||||
| ≥2 joints | 6 (18) | 1 (100) | 7 (22) | 1 (25) | ||
| ESR/CRP >2× ULN | 0 (0) | 1 (100) | 1 (3) | 0 (0) | ||
| PGA ≥7 | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Patient VAS ≥4 | 9 (26) | 1 (100) | 7 (22) | 3 (75) | ||
| ACR and physician correspond | 30 (88) | 0 (0) | 31 (97) | 0 (0) | ||
| AJC (median, IQR) | 0.0 (0.0–1.0) | 3 | 0.10 | 0.0 (0.0–1.0) | 1.0 (1.0–1.5) | 0.14 |
| ESR in mm/hour (median, IQR) | 7.0 (5.0–9.0) | 65 | 0.09 | 7.0 (5.0–9.0) | 8.0 (4.0–12.0) | 0.89 |
| PGA (median, IQR) | 0.1 (0.0–2.0) | 3.0 | 0.07 | 0.0 (0.0–1.3) | 2.8 (2.3–3.5) | 0.003 |
| Patient VAS (median, IQR) | 1.7 (0.5–4.5) | 8.2 | 0.13 | 1.2 (0.4–4.1) | 5.3 (4.0–7.1) | 0.02 |
| cJADAS (median, IQR) | 3.3 (0.8–6.3) | 14.2 | 0.10 | 3.2 (0.6–5.3) | 9.5 (8.7–10.6) | 0.005 |
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. Damaged joint had to be proven radiographically. Without correction for missing data, the ACR-CPG recommended escalation to anti-TNF in 18% of patients with OJIA at 3 months, while only 8% were actually escalated by the physician. At 6 months, only patients not yet escalated (n=36) were analysed. At 6 months, ACR-CPG recommended escalation to anti-TNF in only 3% vs 11% who were actually escalated. Because escalation was recommended in only one patient at 6 months, the items and P values are in italics.
Δ (delta), difference compared with baseline; ACR, American College of Rheumatology; ACR-CPG, ACR clinical practice guideline; AJC, active joint count; cJADAS, clinical Juvenile Arthritis Disease Activity Score; anti-TNF, antitumour necrosis factor therapy; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; OJIA, persistent oligoarticular juvenile idiopathic arthritis; PGA, physician global assessment; ULN, upper limit of normal; VAS, Visual Analogue Scale.