Table 3

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

OJIAACR-CPG recommends anti-TNFP valuePhysician started anti-TNFP value
NoYesNoYes
3 months, N (%)30 (77)7 (18)36 (92)3 (8)
ACR escalation criteria
One of these:
 ≥2 joints8 (27)4 (57)10 (27.8)2 (67)
 ESR/CRP >ULN6 (20)4 (57)10 (27.8)1 (33)
 PGA ≥31 (3)3 (43)2 (5.6)2 (67)
 Patient VAS ≥29 (30)5 (71)12 (33.3)2 (67)
AND one of these:
 Hip/cervical spine0 (0)1 (14)1 (2.8)1 (33)
 Damaged joint ≥10 (0)2 (29)2 (5.6)0 (0)
 Ankle/wrist+>ULN 6 months/ESR >1001 (3)4 (57)5 (13.9)1 (33)
 ACR and physician correspond29 (97)2 (29)31 (86)2 (67)
 AJC (median, IQR)1.0 (0.0–2.0)2.0 (1.0–2.5)0.021.0 (0.0–2.0)2.0 (1.5–2.5)0.12
 ΔAJC (median, IQR)1.0 (1.0–2.0)0 (0–0)0.0061.0 (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)0.3910.0 (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)0.0021.1 (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)0.171.9 (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)0.024.3 (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)0.463.7 (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 joints6 (18) 1 (100) 7 (22)1 (25)
 ESR/CRP >2× ULN0 (0) 1 (100) 1 (3)0 (0)
 PGA ≥70 (0) 0 (0) 0 (0)0 (0)
 Patient VAS ≥49 (26) 1 (100) 7 (22)3 (75)
 ACR and physician correspond30 (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.