Development and testing of reduced joint counts in juvenile idiopathic arthritis (original) (raw)
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The Journal of Rheumatology
Variables for assessment of disease activity of juvenile idiopathic arthritis (JIA) were studied, in order to develop a disease activity score for children with JIA. One randomly chosen hospital visit was studied for each of 312 patients with JIA, with regard to disease activity variables. The physician global assessment score visual analog scale (physician GA) was used as a dependent variable in comparisons between potential disease activity variables. Previous studies have shown this variable to be the most sensitive to changes in JIA disease activity and to be comparable between patients. Based on Spearman's rank order correlation the number of active joints had a strong association with the physician GA. The median physician GA score rose markedly for each active large joint, but less for small joints, although small joints were also statistically important in assessing disease activity. Among the laboratory data, the erythrocyte sedimentation rate, C-reactive protein level,...
Recent advances in quantitative assessment of juvenile idiopathic arthritis
Annals of Paediatric Rheumatology, 2012
No single measure can serve as "gold standard" for the assessment of children with rheumatic diseases. herefore, measurement of the disease status is based on the simultaneous assessment of multiple disease domains. Quantitative measures in pediatric rheumatology have been used primarily in clinical research and therapeutic trials, but have been seldom incorporated in standard clinical care. It is increasingly recognized that regular quantitative assessment in routine practice may help improve the quality of patient care. In the past decade, several new outcome measures for children with juvenile idiopathic arthritis have been developed and validated. Some of these instruments have been designed to be simple and feasible enough to enable their regular use in daily practice. he new measures include criteria for inactive disease, clinical remission and minimal disease activity, deinitions of parent-and child-acceptable symptom state, composite disease activity scores, a damage index, questionnaires for the assessment of physical function and health-related quality of life, 21-numbered circle visual analog scales, and a multidimensional assessment questionnaire. he present review provides a brief description of these clinical tools.
Juvenile Idiopathic Arthritis in a Tertiary Rheumatology Clinic
Annals of Health Research, 2018
Background: Juvenile Idiopathic Arthritis (JIA) is one of the common chronic diseases in childhood. The inflammatory process in the joint is triggered by pro-inflammatory cytokines. The treatment is directed at alleviation of pain, inhibition of disease activity and preservation of range of motion. Objectives: To describe the spectrum of clinical presentations, laboratory parameters and drug therapy among patients with Juvenile Idiopathic Arthritis seen at a Tertiary Health Centre. Methods: All the patients who fulfilled the classification criteria of the International League of Associations for Rheumatology for JIA between July 2012 and June 2016 were included in the study. The clinical features, results of laboratory investigations and the treatment received were recorded. Results: A total of 1910 patients were seen at the Out-Patient Rheumatology Clinic over the 4-year period but only 18 case files of patients with JIA (0.95% of total) were retrieved. There were 13 females and 5 ...
The Journal of Rheumatology, 2011
Objective.To develop and test a new multidimensional questionnaire for assessment of children with juvenile idiopathic arthritis (JIA) in standard clinical care.Methods.The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) includes 15 parent or patient-centered measures or items that assess well-being, pain, functional status, health-related quality of life, morning stiffness, disease activity, disease status and course, joint disease, extraarticular symptoms, side effects of medications, therapeutic compliance, and satisfaction with illness outcome. The JAMAR is proposed for use as both a proxy-report and a patient self-report, with the suggested age range of 7–18 years for use as a self-report. From March 2007 to September 2009, the questionnaire was completed by the parents of 618 children with JIA in 1814 visits and by 332 children in 749 visits.Results.The JAMAR was found to be feasible and to possess face and content validity. All parents and children reported that...
Arthritis & Rheumatism, 2008
Objective. To investigate the disease outcomes of a cross-sectional sample of children with longstanding juvenile idiopathic arthritis (JIA) seen between September 2002 and December 2006, and to provide a benchmarking of outcomes obtained with current treatment. Methods. All consecutive patients were included if they met the following criteria: diagnosis of JIA, disease duration >5 years, and informed consent. Outcome assessments included disease activity, inactive disease, minimal disease activity, pain, physical function, health-related quality of life (HRQOL), auxometric measurements, and articular and extraarticular damage. Results. A total of 310 patients were included. At study visit, patients had on average a low level of disease activity. However, only 21.8% met the criteria for inactive disease, and less than 50% met the definition of minimal disease activity. Additionally, 19.2% had moderate to severe Childhood Health Assessment Questionnaire disability and 3.6% were in Steinbrocker class III-IV. Approximately 10% had major impairment in HRQOL. A total of 34.2% had damage in >1 joint or joint group and 26.1% showed extraarticular damage. Of the 125 patients who underwent a wrist radiograph, 35.2% had significant structural damage and 8.7% had growth retardation. Conclusion. Our patients had on average a low level of disease activity, little or no physical disability, and a satisfactory HRQOL. However, a sizable proportion of patients had persistently active disease, impaired function, and damage. These findings underscore the critical need for treatments and treatment strategies that have the ability to better control disease activity and to reduce the development of disease-related morbidities.
Pediatric rheumatology online journal, 2017
To characterize the existing national and multi-national registries and cohort studies in juvenile idiopathic arthritis (JIA) and identify differences as well as areas of potential future collaboration. We surveyed investigators from North America, Europe, and Australia about existing JIA cohort studies and registries. We excluded cross-sectional studies. We captured information about study design, duration, location, inclusion criteria, data elements and collection methods. We received survey results from 18 studies, including 11 national and 7 multi-national studies representing 37 countries in total. Study designs included inception cohorts, prevalent disease cohorts, and new treatment cohorts (several of which contribute to pharmacosurveillance activities). Despite numerous differences, the data elements collected across the studies was quite similar, with most studies collecting at least 5 of the 6 American College of Rheumatology core set variables and the data needed to calcu...
The Journal of Rheumatology
Objective.To revise the current juvenile idiopathic arthritis (JIA) International League of Associations for Rheumatology (ILAR) classification criteria with an evidence-based approach, using clinical and routine laboratory measures available worldwide, to identify homogeneous clinical groups and to distinguish those forms of chronic arthritis typically seen only in children from the childhood counterpart of adult diseases.Methods.The overall project consists of 4 steps. This work represents Step 1, a Delphi Web-based consensus and Step 2, an international nominal group technique (NGT) consensus conference for the new provisional Pediatric Rheumatology International Trials Organization JIA classification criteria. A future large data collection of at least 1000 new-onset JIA patients (Step 3) followed by analysis and NGT consensus (Step 4) will provide data for the evidence-based validation of the JIA classification criteria.Results.In Step 1, three Delphi rounds of interactions wer...
Arthritis & Rheumatology, 2022
ObjectiveTo provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype.MethodsWe developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.ResultsRecommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well‐balanced, age‐appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision‐making with patients/caregiv...