PJIA | ACR-CPG recommends anti-TNF | P value | Physician started anti-TNF | P value | ||
No | Yes | No | Yes | |||
3 months, N (%) | 14 (19) | 44 (59) | 60 (81) | 13 (18) | ||
ACR escalation criteria | ||||||
One of these: | ||||||
≥5 joints | 0 (0) | 23 (52) | 14 (23) | 10 (77) | ||
ESR/CRP >ULN | 0 (0) | 15 (34) | 9 (15) | 6 (46) | ||
PGA ≥4 | 0 (0) | 11 (25) | 6 (10) | 5 (38) | ||
Patient VAS ≥2 | 0 (0) | 29 (66) | 20 (33) | 9 (69) | ||
ACR and physician correspond | 14 (100) | 13 (30) | 14 (23) | 13 (100) | ||
AJC (median, IQR) | 1.0 (0.0–2.0) | 5.0 (2.5–6.5) | <0.0005 | 2.0 (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) | 0.002 | 3.0 (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) | 0.10 | 11.0 (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) | <0.0005 | 1.5 (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) | <0.0005 | 1.9 (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) | <0.0005 | 6.7 (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) | 0.003 | 6.6 (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 joint | 0 (0) | 39 (91) | 31 (58) | 8 (100) | ||
ESR/CRP >ULN | 0 (0) | 16 (37) | 12 (23) | 4 (50) | ||
PGA >0 | 0 (0) | 39 (91) | 31 (58) | 8 (100) | ||
Patient VAS ≥2 | 0 (0) | 18 (42) | 11 (21) | 7 (88) | ||
ACR and physician correspond | 13 (100) | 8 (19) | 13 (25) | 8 (100) | ||
AJC (median, IQR) | 0 (0.0–0.0) | 2.0 (1.0–3.5) | <0.0005 | 1.0 (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) | 0.52 | 7.0 (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) | <0.0005 | 0.7 (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) | 0.002 | 0.7 (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) | <0.0005 | 2.8 (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.