Article Text

Download PDFPDF
Extended report
Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting
  1. E B Nordal1,2,3,
  2. M Zak4,
  3. K Aalto5,
  4. L Berntson6,
  5. A Fasth7,
  6. T Herlin8,
  7. P Lahdenne5,
  8. S Nielsen4,
  9. S Peltoniemi5,
  10. B Straume3,
  11. M Rygg9
  1. 1Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway
  2. 2Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
  3. 3Department of Community Medicine, University of Tromsø, Tromsø, Norway
  4. 4University Clinic of Pediatrics II, Rigshospitalet, Copenhagen, Denmark
  5. 5Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
  6. 6Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  7. 7Department of Pediatrics, University of Gothenburg, Göteborg, Sweden
  8. 8Department of Pediatrics, Århus University Hospital, Skejby, Denmark,
  9. 9Department of Laboratory Medicine, Children's and Women's health, The Norwegian University of Science and Technology (NTNU), and Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
  1. Correspondence to E B Nordal, Department of Pediatrics, University Hospital of North Norway, N 9038, Tromsø, Norway; ellen.nordal{at}


Objective To compare the juvenile arthritis disease activity score (JADAS) based on C reactive protein (CRP) (JADAS-CRP) with JADAS based on erythrocyte sedimentation rate (ESR) (JADAS-ESR) and to validate JADAS in a population-based setting.

Methods The CRP and ESR values and the corresponding JADAS scores (JADAS10/27/71) were compared in a longitudinal cohort study of 389 children newly diagnosed with juvenile idiopathic arthritis (JIA) in the Nordic JIA study. The construct validity and the discriminative and predictive ability of JADAS were assessed during a median disease course of 8 years by comparing JADAS with other measures of disease activity and outcome.

Results At the first study visit the correlation between JADAS27-CRP and JADAS27-ESR was r=0.99 whereas the correlation between CRP and ESR was r=0.57. Children with higher JADAS scores had an increased risk of concomitant pain, physical disability and use of disease-modifying antirheumatic drugs (DMARDs). A higher JADAS score at the first study visit also significantly predicted physical disability, damage and no remission off medication at the final study visit, and also use of DMARDs during the disease course. Sensitivity to change, demonstrated as change in JADAS score compared with the American College of Rheumatology paediatric measures of improvement criteria, mostly showed excellent classification ability.

Conclusion The JADAS-CRP and JADAS-ESR correlate closely, show similar test characteristics and are feasible and valid tools for assessing disease activity in JIA.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This work was supported by grants from the Helse Nord Research Program.

  • Competing interests None.

  • Ethical approval Approval was granted from the medical ethical committees and data authorities according to the regulations in each participating country.

  • Patient consent Written informed consent was obtained from parents or from the children aged ≥16 years.

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